Provider Demographics
NPI:1932325719
Name:RAFFO, CHRISTINE M (AUD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:RAFFO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:RAFFO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12153-0329
Mailing Address - Country:US
Mailing Address - Phone:518-674-2802
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE CENTRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6344
Practice Address - Country:US
Practice Address - Phone:518-690-2060
Practice Address - Fax:518-690-7111
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000758-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist