Provider Demographics
NPI:1497796635
Name:RASKIN, MARY KATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:RASKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WESTFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-451-1867
Mailing Address - Fax:401-274-0091
Practice Address - Street 1:51 WESTFORD ROAD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-451-1867
Practice Address - Fax:401-274-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI003872OtherBLUE CHIP
RI218230OtherTUFTS HEALTH PLAN
RI62-19051OtherUNITED BEHAVIORAL HEALTH
RI30713-8OtherBLUE CROSS
RIMR03483Medicaid
RI62-19051OtherUNITED BEHAVIORAL HEALTH