Provider Demographics
NPI:1407125883
Name:KESCHNER, RAFAELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:RAFAELLA
Middle Name:
Last Name:KESCHNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAFAELLA
Other - Middle Name:
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:177 N DEAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2523
Mailing Address - Country:US
Mailing Address - Phone:201-503-0038
Mailing Address - Fax:
Practice Address - Street 1:177 N DEAN ST STE 203
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-503-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057790001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical