Provider Demographics
NPI:1295108660
Name:RAIKE, SUSAN GAIL (RPT-S,BCABA,LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAIL
Last Name:RAIKE
Suffix:
Gender:F
Credentials:RPT-S,BCABA,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WILD OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3357
Mailing Address - Country:US
Mailing Address - Phone:407-671-6965
Mailing Address - Fax:
Practice Address - Street 1:461 WILD OAK CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3357
Practice Address - Country:US
Practice Address - Phone:407-671-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst