Provider Demographics
NPI:1962003517
Name:RAFFERTY, MEGAN AILEEN (MED, LPCC, LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:AILEEN
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:MED, LPCC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 TRUJILLO RD. S.W.
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2857
Mailing Address - Country:US
Mailing Address - Phone:505-249-0945
Mailing Address - Fax:
Practice Address - Street 1:1564 TRUJILLO RD. S.W.
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2857
Practice Address - Country:US
Practice Address - Phone:505-249-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0082181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional