Provider Demographics
NPI:1689675787
Name:RAFFERTY, CYNDIA LEE (RN, PC)
Entity Type:Individual
Prefix:
First Name:CYNDIA
Middle Name:LEE
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:RN, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:800-407-8118
Mailing Address - Fax:800-555-2336
Practice Address - Street 1:282 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1229
Practice Address - Country:US
Practice Address - Phone:978-758-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0541OtherBLUE SHIELD MA
MA006904OtherHARVARD PILGRIM
MA233767OtherMAGELLAN
MA233767OtherMAGELLAN
MAPN0541OtherBLUE SHIELD MA