Provider Demographics
NPI:1982030490
Name:RAPHAEL, CHRISTINA GERALDINE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GERALDINE
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2264
Mailing Address - Country:US
Mailing Address - Phone:954-595-2666
Mailing Address - Fax:
Practice Address - Street 1:2640 SW 6TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2264
Practice Address - Country:US
Practice Address - Phone:954-595-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical