Provider Demographics
NPI:1386030104
Name:RAFFIA, MARIA (LCSW, PMH-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RAFFIA
Suffix:
Gender:F
Credentials:LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PENDLETON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4024
Mailing Address - Country:US
Mailing Address - Phone:203-401-8935
Mailing Address - Fax:
Practice Address - Street 1:61 PENDLETON ST # 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4024
Practice Address - Country:US
Practice Address - Phone:203-401-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0108791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker