Provider Demographics
NPI:1699110064
Name:MICHAEL N. RASKIN PA
Entity type:Organization
Organization Name:MICHAEL N. RASKIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:207-353-7254
Mailing Address - Street 1:8 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-1505
Mailing Address - Country:US
Mailing Address - Phone:207-353-7254
Mailing Address - Fax:207-353-7258
Practice Address - Street 1:8 MAIN ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1505
Practice Address - Country:US
Practice Address - Phone:207-353-7254
Practice Address - Fax:207-353-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS 345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134320000Medicaid
MEPTAN 703823Medicare UPIN