Provider Demographics
NPI:1831496033
Name:RAAB, BETHANY J (LCSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:RAAB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5353 W DARTMOUTH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5516
Mailing Address - Country:US
Mailing Address - Phone:720-722-0527
Mailing Address - Fax:303-586-1196
Practice Address - Street 1:5353 W DARTMOUTH AVE STE 203
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-5516
Practice Address - Country:US
Practice Address - Phone:720-722-0527
Practice Address - Fax:303-586-1196
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36674214Medicaid
CO43235247Medicaid