Healthcare Provider Details

I. General information

NPI: 1063749117
Provider Name (Legal Business Name): RAFFAELA PETER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 W. OAKLAND PARK BLVD. STE 100
LAUDERHILL FL
33319-4985
US

IV. Provider business mailing address

PO BOX 400
COTOPAXI CO
81223-0400
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 719-285-5121
  • Fax: 719-218-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: