Basic Information
| Provider Information | |||||||||
| NPI: | 1790250868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFOS | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CASAC 2 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MATTHEWS STREET | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948009 | ||||||||
| FaxNumber: | 8452941369 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 MATTHEWS ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948009 | ||||||||
| FaxNumber: | 8452941369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2018 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 18880 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.