=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477402949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE JENNIFER RAPHAEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 N PEARL ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02301-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-858-7142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1047 PLEASANT ST
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02021-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-858-7142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2349301
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------