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NPI Code Detail

MEDICARE: MS. KANTHI C RAJA LISW-S

MEDICARE: MS. KANTHI C RAJA LISW-S
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
1103TC0700XClinical Psychologist025337NY

General Provider Information

NPI Number : 1548591464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KANTHI C RAJA LISW-S
Provider Business Mailing Address
First Line : 77 MILFORD DR
Second Line : SUITE 218
City : HUDSON
State : OH
Zip : 44236-2781
Country : US
Telephone Number : 330-650-4423
Fax Number : 330-655-4329
Provider Business Practice Location Address
First Line : 230 S COURT ST
Second Line : SUITE 5
City : MEDINA
State : OH
Zip : 44256-2275
Country : US
Telephone Number : 330-723-7977
Fax Number : 330-725-5177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2010
Last Update Date : 03/03/2026

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