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NPI Code Detail

MEDICARE: MELISSA RAAB LMFT

MEDICARE: MELISSA RAAB LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist001165NY

General Provider Information

NPI Number : 1497277669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA RAAB LMFT
Provider Business Mailing Address
First Line : 3070 BELGIUM RD
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-9546
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3070 BELGIUM RD
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-9546
Country : US
Telephone Number : 315-313-8638
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2017
Last Update Date : 07/10/2017

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