Provider Demographics
NPI:1205581436
Name:RAPHAEL, ALEXANDRA (LICSW)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SLIGO AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4716
Mailing Address - Country:US
Mailing Address - Phone:202-415-3340
Mailing Address - Fax:
Practice Address - Street 1:614 SLIGO AVE APT 405
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4716
Practice Address - Country:US
Practice Address - Phone:202-415-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500824301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical