Provider Demographics
NPI:1891781001
Name:RAFFERTY, WILLIAM J (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WASHINGTON ST
Mailing Address - Street 2:STE. 22
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2337
Mailing Address - Country:US
Mailing Address - Phone:781-769-9170
Mailing Address - Fax:781-769-1016
Practice Address - Street 1:470 WASHINGTON ST
Practice Address - Street 2:STE. 22
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2337
Practice Address - Country:US
Practice Address - Phone:781-769-9170
Practice Address - Fax:781-769-1016
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0513562Medicaid
MA0513562Medicaid
MAR43221Medicare UPIN