Provider Demographics
NPI:1528084076
Name:RAAB, DIANE E (MSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:RAAB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25490 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2157
Mailing Address - Country:US
Mailing Address - Phone:586-779-8003
Mailing Address - Fax:586-779-8146
Practice Address - Street 1:25490 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2157
Practice Address - Country:US
Practice Address - Phone:586-779-8003
Practice Address - Fax:586-779-8146
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010163931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPO852001Medicare ID - Type UnspecifiedINDIVIDUAL
MIOPO8520Medicare ID - Type UnspecifiedGROUP