Healthcare Provider Details

I. General information

NPI: 1811497340
Provider Name (Legal Business Name): JOSHUA RAINES LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 S GRANT AVE
COLUMBUS OH
43215-5549
US

IV. Provider business mailing address

398 S GRANT AVE
COLUMBUS OH
43215-5549
US

V. Phone/Fax

Practice location:
  • Phone: 614-716-0891
  • Fax: 614-716-0902
Mailing address:
  • Phone: 614-716-0891
  • Fax: 614-716-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1440159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: