Provider Demographics
NPI:1578030284
Name:RAINES, MORGAN K (LISW)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:K
Last Name:RAINES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:KAY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MASW
Mailing Address - Street 1:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:
Practice Address - Street 1:1425 N FAIRFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2674
Practice Address - Country:US
Practice Address - Phone:937-641-5772
Practice Address - Fax:937-641-4668
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23048951041C0700X
OHS.1801941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0324097Medicaid