Provider Demographics
NPI:1467607747
Name:RAPHAEL-KUPFERBERG, RACHEL (C/SIPT,MA,OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:RAPHAEL-KUPFERBERG
Suffix:
Gender:F
Credentials:C/SIPT,MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2225
Mailing Address - Country:US
Mailing Address - Phone:151-682-9296
Mailing Address - Fax:
Practice Address - Street 1:16315 21ST RD
Practice Address - Street 2:Q PS 184
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4000
Practice Address - Country:US
Practice Address - Phone:171-835-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004113-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor