Provider Demographics
NPI:1376014506
Name:RAFTERY RAMIREZ, MARYCILENE (MSC)
Entity Type:Individual
Prefix:
First Name:MARYCILENE
Middle Name:
Last Name:RAFTERY RAMIREZ
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:MRS
Other - First Name:MARYCILENE
Other - Middle Name:
Other - Last Name:RAFTERY RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:101Y00000X
Mailing Address - Street 1:4 CANAL PARK PH 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2207
Mailing Address - Country:US
Mailing Address - Phone:617-800-7005
Mailing Address - Fax:
Practice Address - Street 1:14 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3006
Practice Address - Country:US
Practice Address - Phone:617-620-5894
Practice Address - Fax:617-782-6444
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst