Provider Demographics
NPI:1316979024
Name:RAISCHEL, JEFFREY B (PSYD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:RAISCHEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPRING ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3457
Mailing Address - Country:US
Mailing Address - Phone:508-824-0614
Mailing Address - Fax:508-824-9451
Practice Address - Street 1:21 SPRING ST STE 1
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3457
Practice Address - Country:US
Practice Address - Phone:508-824-0614
Practice Address - Fax:508-824-9451
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8526103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist