Provider Demographics
NPI:1831679679
Name:RAPHAEL, DANIEL S (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:S
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GROVE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2833
Mailing Address - Country:US
Mailing Address - Phone:908-393-2725
Mailing Address - Fax:
Practice Address - Street 1:350 GROVE ST STE 206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2833
Practice Address - Country:US
Practice Address - Phone:908-393-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010298101YP2500X
NJ37PC00598500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional