Provider Demographics
NPI:1952392847
Name:RAFFEL, KEN E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:E
Last Name:RAFFEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:E
Other - Last Name:RAFFEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:41 CARLETON STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3225
Mailing Address - Country:US
Mailing Address - Phone:207-329-0852
Mailing Address - Fax:207-761-8150
Practice Address - Street 1:30 MILK STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5116
Practice Address - Country:US
Practice Address - Phone:207-329-0852
Practice Address - Fax:207-839-4704
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC54071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7261Medicare ID - Type Unspecified