Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 7342 | MA |
N | 103T00000X | Psychologist | 7342 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 7342 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 7342 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 7342 | MA |
N | 103G00000X | Clinical Psychologist | 7342 | MA |
N | 103TC0700X | Clinical Psychologist | 7342 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7342 | MA |
N | 103TE1100X | Exercise & Sports Psychologist | 7342 | MA |
N | 103TH0100X | Health Service | 7342 | MA |
NPI | 1366487068 |
---|---|
Provider Name | Ingrid E Raab |
First Address | Wellesley, MA 02482-6931 |
Second Address | Wellesley, MA 02482-6418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0527025 | (05) | MA |
7529313 | A ETNAUS HEALTHCARE (01) | MA |