Healthcare Provider Details

I. General information

NPI: 1659209104
Provider Name (Legal Business Name): RAISA HASAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 MACON LN
NEW KENT VA
23124-3323
US

IV. Provider business mailing address

11750 MACON LN
NEW KENT VA
23124-3323
US

V. Phone/Fax

Practice location:
  • Phone: 646-610-1878
  • Fax:
Mailing address:
  • Phone: 646-610-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: