Provider Demographics
NPI:1295080372
Name:RAIGOZA-RAMIREZ, MIRTHA (MSW)
Entity type:Individual
Prefix:
First Name:MIRTHA
Middle Name:
Last Name:RAIGOZA-RAMIREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 EUCLID AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3472
Mailing Address - Country:US
Mailing Address - Phone:708-783-7430
Mailing Address - Fax:708-783-7434
Practice Address - Street 1:3231 EUCLID AVE STE 407
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3472
Practice Address - Country:US
Practice Address - Phone:708-783-7430
Practice Address - Fax:708-783-7434
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker