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NPI Code Detail

MEDICARE: MR. RAPHAEL BEN-YEHUDA LCSW-R

MEDICARE: MR. RAPHAEL BEN-YEHUDA LCSW-R
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
11041C0700XClinical Social Worker083871-1NY
21041C0700XClinical Social Worker086954-1NY
31041C0700XClinical Social Worker083871-RNY

General Provider Information

NPI Number : 1871847830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAPHAEL BEN-YEHUDA LCSW-R
Provider Business Mailing Address
First Line : 1270 5TH AVE APT 12H
Second Line :
City : NEW YORK
State : NY
Zip : 10029-3427
Country : US
Telephone Number : 646-419-4778
Fax Number :
Provider Business Practice Location Address
First Line : 150 W 28TH ST STE 1901
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6179
Country : US
Telephone Number : 646-419-4778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2012
Last Update Date : 01/25/2021

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