Healthcare Provider Details

I. General information

NPI: 1902673791
Provider Name (Legal Business Name): SARAH RAPHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

IV. Provider business mailing address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

V. Phone/Fax

Practice location:
  • Phone: 617-533-0416
  • Fax:
Mailing address:
  • Phone: 617-533-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: