Provider Demographics
NPI:1942050273
Name:RAFALAK, JASON (LSW, MT-BC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RAFALAK
Suffix:
Gender:M
Credentials:LSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIBERTY
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4119
Mailing Address - Country:US
Mailing Address - Phone:412-310-4011
Mailing Address - Fax:
Practice Address - Street 1:4 SMITHFIELD ST STE 520
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2226
Practice Address - Country:US
Practice Address - Phone:412-354-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1406761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical