Provider Demographics
NPI:1417412107
Name:RAVURI, MAUREEN SUSMITA SAMUEL (LIMHP, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SUSMITA SAMUEL
Last Name:RAVURI
Suffix:
Gender:F
Credentials:LIMHP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2637
Mailing Address - Country:US
Mailing Address - Phone:402-819-7868
Mailing Address - Fax:
Practice Address - Street 1:4383 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1008
Practice Address - Country:US
Practice Address - Phone:402-819-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042622756OtherCCA
MA12529OtherHNE
MA1134107113OtherBEACON
MA1134107113OtherFALLON
MA1134107113Medicaid
MA1134107113OtherMBHP
MA71756OtherTUFTS
MA1134107113OtherNHP
MA997303OtherNETWORK HEALTH
MAY10086OtherMEDICARE