Provider Demographics
NPI:1457734857
Name:RAGHAV, PRIYA (LICSW)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:RAGHAV
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:SWAMINATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1534 BISHOP ROAD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-357-2370
Mailing Address - Fax:360-357-2374
Practice Address - Street 1:1534 BISHOP ROAD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-357-2370
Practice Address - Fax:360-357-2374
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604091421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical