Provider Demographics
NPI:1083326466
Name:RAFFAELLI, KIMBERLY (LMHC, NCC, BCN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RAFFAELLI
Suffix:
Gender:F
Credentials:LMHC, NCC, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SQUARE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5613
Mailing Address - Country:US
Mailing Address - Phone:845-232-0703
Mailing Address - Fax:
Practice Address - Street 1:15 SQUARE WOODS DR
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5613
Practice Address - Country:US
Practice Address - Phone:845-232-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health