MEDICARE: KATRIN RAFAILOV EDM, MA

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1710865589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRIN RAFAILOV EDM, MA

Provider Business Mailing Address
First Line	:	162 NORFOLK ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2306
Country	:	US
Telephone Number	:	718-704-8967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 S ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4328
Country	:	US
Telephone Number	:	718-704-8967
Fax Number	:

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

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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