MEDICARE: MS. BONNI RAAB LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	014543-R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205095	OTHER	NY	UNITED BEHAVIORAL HEALTH
2	DR8999	OTHER	NY	OXFORD
3	7492802	OTHER	NY	GHI & VALUE OPTIONS

General Provider Information

NPI Number	:	1275535023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNI RAAB LCSW

Provider Business Mailing Address
First Line	:	978 ROUTE 45
Second Line	:	SUITE 200
City	:	POMONA
State	:	NY
Zip	:	10970-3565
Country	:	US
Telephone Number	:	845-364-9422
Fax Number	:	845-364-9422

Provider Business Practice Location Address
First Line	:	978 ROUTE 45
Second Line	:	SUITE 200
City	:	POMONA
State	:	NY
Zip	:	10970-3565
Country	:	US
Telephone Number	:	845-364-9422
Fax Number	:	845-364-9422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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