Provider Demographics
NPI:1114947975
Name:RAFALSON, LUBA (PHD)
Entity Type:Individual
Prefix:
First Name:LUBA
Middle Name:
Last Name:RAFALSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 UPPER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1205
Mailing Address - Country:US
Mailing Address - Phone:908-996-6862
Mailing Address - Fax:
Practice Address - Street 1:264 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6224
Practice Address - Country:US
Practice Address - Phone:610-866-9311
Practice Address - Fax:610-882-2072
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical