MEDICARE: SARA RAFFERTY LMHC

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	101YM0800X	Mental Health Counselor	MH 5551	FL

General Provider Information

NPI Number	:	1669508644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA RAFFERTY LMHC

Provider Business Mailing Address
First Line	:	1384 BLACK WILLOW TRL
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1156
Country	:	US
Telephone Number	:	407-927-0937
Fax Number	:	407-682-4405

Provider Business Practice Location Address
First Line	:	375 DOUGLAS AVE STE 2005
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3315
Country	:	US
Telephone Number	:	407-529-5359
Fax Number	:	407-682-4405

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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