Provider Demographics
NPI:1952812505
Name:REDDING-RAINES, AUDREY (PHD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:REDDING-RAINES
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 1:50 UNION AVE STE 804B
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-5221
Mailing Address - Country:US
Mailing Address - Phone:201-709-4094
Mailing Address - Fax:
Practice Address - Street 1:50 UNION AVE STE 804B
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-5221
Practice Address - Country:US
Practice Address - Phone:201-709-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker