Provider Demographics
NPI:1568697050
Name:RAFFAELE, MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:RAFFAELE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ALICE RD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2903
Mailing Address - Country:US
Mailing Address - Phone:516-993-3688
Mailing Address - Fax:631-328-3162
Practice Address - Street 1:170 LITTLE EAST NECK RD
Practice Address - Street 2:2
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7742
Practice Address - Country:US
Practice Address - Phone:516-993-3688
Practice Address - Fax:631-328-3162
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2015-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0806611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400126210Medicare PIN