Provider Demographics
NPI:1164114500
Name:RAFALA, RACHAEL GRACE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:GRACE
Last Name:RAFALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3204
Mailing Address - Country:US
Mailing Address - Phone:860-249-0975
Mailing Address - Fax:
Practice Address - Street 1:54 FOREST ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3204
Practice Address - Country:US
Practice Address - Phone:860-249-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health