Provider Demographics
NPI:1780762146
Name:AVI RAPHAELI PHD PC
Entity type:Organization
Organization Name:AVI RAPHAELI PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-984-0333
Mailing Address - Street 1:909 FROSTWOOD
Mailing Address - Street 2:163
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2308
Mailing Address - Country:US
Mailing Address - Phone:713-984-0333
Mailing Address - Fax:713-984-9838
Practice Address - Street 1:909 FROSTWOOD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2308
Practice Address - Country:US
Practice Address - Phone:713-984-0333
Practice Address - Fax:713-984-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX21764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
TXLL08Medicare ID - Type Unspecified