Provider Demographics
NPI:1942536172
Name:RAPHAEL, JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 PORTOLA AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 PORTOLA AVE
Practice Address - Street 2:APT. A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2147
Practice Address - Country:US
Practice Address - Phone:310-540-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS193881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical