Provider Demographics
NPI:1023677291
Name:RAYDER, ABIGAIL MORIAH (LSW, CDCA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MORIAH
Last Name:RAYDER
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9041
Mailing Address - Country:US
Mailing Address - Phone:330-345-7949
Mailing Address - Fax:
Practice Address - Street 1:2685 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9041
Practice Address - Country:US
Practice Address - Phone:330-345-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.170183101YA0400X
OHS.1904087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353401Medicaid