Provider Demographics
NPI:1669565354
Name:RAAB-COHEN, SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RAAB-COHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 WESTERN AVE.
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2213
Mailing Address - Country:US
Mailing Address - Phone:206-443-9810
Mailing Address - Fax:206-448-4899
Practice Address - Street 1:2003 WESTERN AVE.
Practice Address - Street 2:SUITE 340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2213
Practice Address - Country:US
Practice Address - Phone:206-443-9810
Practice Address - Fax:206-448-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA828103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA828OtherPSYCHOLOGY LICENSE