Provider Demographics
NPI:1548591464
Name:RAJA, KANTHI C (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:KANTHI
Middle Name:C
Last Name:RAJA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MILFORD DR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2781
Mailing Address - Country:US
Mailing Address - Phone:330-650-4423
Mailing Address - Fax:330-655-4329
Practice Address - Street 1:230 S COURT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2275
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:330-725-5177
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00089681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical