Provider Demographics
NPI:1962731307
Name:RASKIN, KEITH (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:RASKIN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0809
Mailing Address - Country:US
Mailing Address - Phone:407-846-5294
Mailing Address - Fax:407-846-5298
Practice Address - Street 1:5970 S. ORANGE BLOSSOM TR.
Practice Address - Street 2:
Practice Address - City:INTERCESSION CITY
Practice Address - State:FL
Practice Address - Zip Code:33848
Practice Address - Country:US
Practice Address - Phone:407-846-5294
Practice Address - Fax:407-846-5298
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health