Healthcare Provider Details

I. General information

NPI: 1528144144
Provider Name (Legal Business Name): JAMES RICHARD RAIA PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WEST BROAD STREET TWIN VALLEY
COLUMBUS OH
43223
US

IV. Provider business mailing address

2200 WEST BROAD STREET
COLUMBUS OH
43223-1297
US

V. Phone/Fax

Practice location:
  • Phone: 614-752-0333
  • Fax: 614-752-0385
Mailing address:
  • Phone: 614-752-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: