Provider Demographics
NPI:1366693442
Name:RAFFETTO, LAURIE (MA LPC #C2732)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:RAFFETTO
Suffix:
Gender:F
Credentials:MA LPC #C2732
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 MOONSTONE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3518
Mailing Address - Country:US
Mailing Address - Phone:503-581-6646
Mailing Address - Fax:
Practice Address - Street 1:1320 EDGEWATER ST NW STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4153
Practice Address - Country:US
Practice Address - Phone:503-910-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health