Provider Demographics
NPI:1265178248
Name:RAJA, KISHAN (LMSW)
Entity type:Individual
Prefix:
First Name:KISHAN
Middle Name:
Last Name:RAJA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S LAKESHORE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7157
Mailing Address - Country:US
Mailing Address - Phone:480-256-9299
Mailing Address - Fax:480-422-2474
Practice Address - Street 1:4801 S LAKESHORE DR STE 204
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7157
Practice Address - Country:US
Practice Address - Phone:480-256-9299
Practice Address - Fax:480-422-2474
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ189991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical