Provider Demographics
NPI:1588914220
Name:RASCHDORF, NICOLE M (BSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:RASCHDORF
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 MEMORIAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4509
Mailing Address - Country:US
Mailing Address - Phone:813-891-9474
Mailing Address - Fax:
Practice Address - Street 1:6323 MEMORIAL HWY STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4509
Practice Address - Country:US
Practice Address - Phone:813-891-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker