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General NPI Number Information
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NPI Number | 1720090541
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Entity Type | Individual
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Provider Name | JONATHAN D. RASKIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 09/02/2023
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Provider Practice Location Address
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Address Line | 33 EVERGREEN LN
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City | NEW PALTZ
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State | NY
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Zip | 12561-4445
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Country | US
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Telephone | 845-582-3107
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Fax | 845-241-7375
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Provider Business Mailing Address
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Address Line | 33 EVERGREEN LN
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City | NEW PALTZ
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State | NY
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Zip | 12561-4445
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Country | US
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Telephone | 845-582-3107
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Fax | 845-241-7375
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 013081
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License Number State | NY
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