Provider Demographics
NPI:1174829006
Name:DR. RAPHAEL WALD LLC
Entity Type:Organization
Organization Name:DR. RAPHAEL WALD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-245-4622
Mailing Address - Street 1:7777 GLADES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4194
Mailing Address - Country:US
Mailing Address - Phone:561-245-4622
Mailing Address - Fax:877-887-3760
Practice Address - Street 1:7777 GLADES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4194
Practice Address - Country:US
Practice Address - Phone:561-245-4622
Practice Address - Fax:877-887-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty