Provider Demographics
NPI:1528886777
Name:RAVER, JOAN (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:RAVER
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1312
Mailing Address - Country:US
Mailing Address - Phone:317-299-9268
Mailing Address - Fax:
Practice Address - Street 1:120 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1312
Practice Address - Country:US
Practice Address - Phone:317-299-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1130669103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty