Provider Demographics
NPI:1720311079
Name:RAEL, ROSELYN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSELYN
Middle Name:H
Last Name:RAEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 2238
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-758-4297
Mailing Address - Fax:575-751-7237
Practice Address - Street 1:1337 GUSDORF ROAD
Practice Address - Street 2:SUITES E & F
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5227
Practice Address - Country:US
Practice Address - Phone:575-758-4297
Practice Address - Fax:575-751-7237
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-44801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical