Healthcare Provider Details

I. General information

NPI: 1346454840
Provider Name (Legal Business Name): KRISTIN MARIA RABER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 OPPENHEIMER DR SUITE 200
LOS ALAMOS NM
87544-2384
US

IV. Provider business mailing address

2175 37TH ST APT A
LOS ALAMOS NM
87544-2498
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-4383
  • Fax:
Mailing address:
  • Phone: 505-662-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: