Provider Demographics
NPI:1609530971
Name:REICHEL, RAPHAEL REICHEL
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:REICHEL
Last Name:REICHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CITY AVE UNIT EC405
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3907
Mailing Address - Country:US
Mailing Address - Phone:718-887-1108
Mailing Address - Fax:
Practice Address - Street 1:1001 CITY AVE UNIT EC405
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3907
Practice Address - Country:US
Practice Address - Phone:718-887-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2787031103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool