MEDICARE: MR. PATRICK ANTHONY RAGGHIANTI MS ED.

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1902358757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK ANTHONY RAGGHIANTI MS ED.

Provider Business Mailing Address
First Line	:	2165 SPICER CV STE 5
Second Line	:	MEMPHIS NORTH TREATMENT CENTER
City	:	MEMPHIS
State	:	TN
Zip	:	38134-5623
Country	:	US
Telephone Number	:	901-372-7878
Fax Number	:	901-373-9298

Provider Business Practice Location Address
First Line	:	2165 SPICER CV
Second Line	:	SUITE 5
City	:	MEMPHIS
State	:	TN
Zip	:	38134-5623
Country	:	US
Telephone Number	:	901-372-7878
Fax Number	:	901-373-9298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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