Provider Demographics
NPI:1235737222
Name:REVELLA, RAPHAEL ANGELA (MSW)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:ANGELA
Last Name:REVELLA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2541
Mailing Address - Country:US
Mailing Address - Phone:518-630-8351
Mailing Address - Fax:
Practice Address - Street 1:2070 CURRY RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4400
Practice Address - Country:US
Practice Address - Phone:518-356-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker