Provider Demographics
NPI:1417123795
Name:WILLEY, RAQUEL J
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:J
Last Name:WILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N CAPITOL AVE
Mailing Address - Street 2:UNIT 212
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2376
Mailing Address - Country:US
Mailing Address - Phone:510-857-4056
Mailing Address - Fax:
Practice Address - Street 1:247 N CAPITOL AVE
Practice Address - Street 2:UNIT 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2376
Practice Address - Country:US
Practice Address - Phone:510-857-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health