MEDICARE: AMY JILL RAPHAEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	010241	NY
2	103TA0700X	Adult Development & Aging Psychologist	010241	NY
3	103TC0700X	Clinical Psychologist	010241	NY

General Provider Information

NPI Number	:	1538174446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JILL RAPHAEL PH.D.

Provider Business Mailing Address
First Line	:	631 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-1034
Country	:	US
Telephone Number	:	212-724-3035
Fax Number	:	914-693-2981

Provider Business Practice Location Address
First Line	:	631 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-1034
Country	:	US
Telephone Number	:	212-724-3035
Fax Number	:	914-693-2981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	04/04/2023

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