=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427596444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAWA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2017
-----------------------------------------------------
Last Update Date | 02/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28901 TRAILS EDGE BLVD #204
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34134-7588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-565-2117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 314 GULF RD
-----------------------------------------------------
City | COHOES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12047-4983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MRS. CLAIRE A RALLI
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 239-565-2117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW11560
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------