Healthcare Provider Details

I. General information

NPI: 1003910639
Provider Name (Legal Business Name): RAFAL ROBERT WOJCIK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

15292 SW 104TH ST APT.#1115
MIAMI FL
33196-3294
US

V. Phone/Fax

Practice location:
  • Phone: 786-295-5626
  • Fax: 305-575-3298
Mailing address:
  • Phone: 305-388-3267
  • Fax: 305-575-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 6926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: