Provider Demographics
NPI:1790912905
Name:RACIN, REVITAL RAHEL (MD)
Entity Type:Individual
Prefix:
First Name:REVITAL
Middle Name:RAHEL
Last Name:RACIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 7D
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-993-6100
Mailing Address - Fax:617-993-6106
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 7D
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-993-6100
Practice Address - Fax:617-993-6106
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2582052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry