Provider Demographics
NPI:1952389389
Name:LARRY M. RASKIN, PH.D., P.S.C.
Entity Type:Organization
Organization Name:LARRY M. RASKIN, PH.D., P.S.C.
Other - Org Name:PSYCHOLOGY RESOURCE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-394-9990
Mailing Address - Street 1:7400 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 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:502-394-9990
Practice Address - Street 1:7400 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 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:502-394-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY241408000OtherMAGELLAN GROUP NUMBER
KY241408000OtherMAGELLAN GROUP NUMBER