Provider Demographics
NPI:1891169538
Name:RAFAELOV, ELENA (MSSPED)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:RAFAELOV
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 MARCELLUS RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1426
Mailing Address - Country:US
Mailing Address - Phone:917-412-7796
Mailing Address - Fax:
Practice Address - Street 1:362 MARCELLUS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1426
Practice Address - Country:US
Practice Address - Phone:917-412-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst