Provider Demographics
NPI:1881193308
Name:AGUILERA M, JOSE RAFAEL (MS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:AGUILERA M
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQ STE 333W
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5156
Mailing Address - Country:US
Mailing Address - Phone:401-227-0372
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 333W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5156
Practice Address - Country:US
Practice Address - Phone:401-227-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health