Basic Information
| Provider Information | |||||||||
| NPI: | 1992897094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFTER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 BOND ST | ||||||||
| Address2: | |||||||||
| City: | ASBURY PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077125939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328692765 | ||||||||
| FaxNumber: | 7328979541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 BOND ST | ||||||||
| Address2: | |||||||||
| City: | ASBURY PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077125939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328692765 | ||||||||
| FaxNumber: | 7328979541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SW00942700 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.