Provider Demographics
NPI:1093107468
Name:DANIEL RAFFAELE LCSW PC
Entity Type:Organization
Organization Name:DANIEL RAFFAELE LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFFAELE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-795-7561
Mailing Address - Street 1:15 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7350
Mailing Address - Country:US
Mailing Address - Phone:516-795-7561
Mailing Address - Fax:
Practice Address - Street 1:15 JOHN ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7350
Practice Address - Country:US
Practice Address - Phone:516-795-7561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0251881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100122716Medicare PIN