Provider Demographics
NPI:1639978794
Name:OSHIRO, RAVEN SYMONE (PSYD)
Entity type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:SYMONE
Last Name:OSHIRO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CRESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5805
Mailing Address - Country:US
Mailing Address - Phone:917-327-2594
Mailing Address - Fax:
Practice Address - Street 1:425 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1795
Practice Address - Country:US
Practice Address - Phone:347-343-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent