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General NPI Number Information
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NPI Number | 1508554957
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Entity Type | Organization
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Legal Business Name | JENNIFER RAIA, LCSW-C, LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 1407 YORK RD STE 307
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6054
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Country | US
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Telephone | 443-834-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 19312 ENSOR RD
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City | WHITE HALL
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State | MD
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Zip | 21161-8809
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Country | US
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Telephone | 443-834-9270
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | JENNIFER RAIA
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Credential |
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Telephone | 443-834-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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