Provider Demographics
NPI:1518102664
Name:RAPHAEL, SUSAN G (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4744
Mailing Address - Country:US
Mailing Address - Phone:203-227-7644
Mailing Address - Fax:203-227-0037
Practice Address - Street 1:420 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4744
Practice Address - Country:US
Practice Address - Phone:203-227-7644
Practice Address - Fax:203-227-0037
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist