MEDICARE: CHRISTINA GERALDINE RAPHAEL

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982030490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA GERALDINE RAPHAEL

Provider Business Mailing Address
First Line	:	2640 SW 6TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2264
Country	:	US
Telephone Number	:	954-595-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 SW 6TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2264
Country	:	US
Telephone Number	:	954-595-2666
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	02/11/2021

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