Healthcare Provider Details

I. General information

NPI: 1275668444
Provider Name (Legal Business Name): DEBRA N. RAQUET-SAFFORD M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SHERIDAN RD
WINTHROP HARBOR IL
60096-1744
US

IV. Provider business mailing address

1100 SHERIDAN RD
WINTHROP HARBOR IL
60096-1744
US

V. Phone/Fax

Practice location:
  • Phone: 847-322-4109
  • Fax:
Mailing address:
  • Phone: 847-322-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: