Provider Demographics
NPI:1407077738
Name:RAFFERTY, KATHLEEN CASEY (MS LMFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CASEY
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MACAULAY LANE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241
Mailing Address - Country:US
Mailing Address - Phone:941-915-8229
Mailing Address - Fax:941-371-5857
Practice Address - Street 1:4101 MACAULAY LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241
Practice Address - Country:US
Practice Address - Phone:941-915-8229
Practice Address - Fax:941-371-5857
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist