Provider Demographics
NPI:1750360624
Name:RASKIN, LARRY M (PHD,)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:M
Last Name:RASKIN
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 NEW LA GRANGE RD
Mailing Address - Street 2:STE 312
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4870
Mailing Address - Country:US
Mailing Address - Phone:502-394-9990
Mailing Address - Fax:502-394-9992
Practice Address - Street 1:7400 NEW LA GRANGE RD
Practice Address - Street 2:STE 312
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4870
Practice Address - Country:US
Practice Address - Phone:502-394-9990
Practice Address - Fax:502-394-9992
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 0215103TC0700X
IN20010039A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY128578OtherAPS
KY10466OtherCIGNA BEHAVIORAL HEALTH
KY7245146OtherAETNA
KY226159OtherMHN
KY000000047451OtherANTHEM BCBS
KY179632OtherCOMPSYCH
KY89002158Medicaid
KY009408OtherVALUE OPTIONS
KY037902000OtherMAGELLAN
KY6106230OtherUNITED BEHAVIORAL HEALTH
KY226159OtherMHN
KY0613901Medicare PIN
KY009408OtherVALUE OPTIONS