Provider Demographics
NPI:1679006191
Name:AMIR, RAPHAEL KADOORY (AMFT,APCC)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:KADOORY
Last Name:AMIR
Suffix:
Gender:M
Credentials:AMFT,APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5168 HONPIE RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8682
Mailing Address - Country:US
Mailing Address - Phone:530-387-4185
Mailing Address - Fax:
Practice Address - Street 1:5168 HONPIE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8682
Practice Address - Country:US
Practice Address - Phone:530-387-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117377106H00000X
CA7416101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional