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NPI Code Detail

MEDICARE: DR. RAVEN SYMONE OSHIRO PSY.D

MEDICARE: DR. RAVEN SYMONE OSHIRO PSY.D
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
1103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1639978794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAVEN SYMONE OSHIRO PSY.D
Provider Business Mailing Address
First Line : 115 CRESTWOOD BLVD
Second Line :
City : FARMINGDALE
State : NY
Zip : 11735-5805
Country : US
Telephone Number : 917-327-2594
Fax Number :
Provider Business Practice Location Address
First Line : 425 WESTCHESTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10455-1795
Country : US
Telephone Number : 347-343-0568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2025
Last Update Date : 03/11/2025

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