Provider Demographics
NPI:1215171525
Name:PLASENCIA, RAUL ANTONIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:ANTONIO
Last Name:PLASENCIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BLOOMFIELD ST
Mailing Address - Street 2:SUITE #116
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4747
Mailing Address - Country:US
Mailing Address - Phone:201-600-3562
Mailing Address - Fax:201-662-1917
Practice Address - Street 1:223 BLOOMFIELD STREET
Practice Address - Street 2:SUITE 116 RAUL A. PLASENCIA LCSW
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4747
Practice Address - Country:US
Practice Address - Phone:201-600-3562
Practice Address - Fax:201-662-1917
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00595100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
045071Medicare PIN