Provider Demographics
NPI:1366560856
Name:RAPHAEL-PASKEY, ANDREA M (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:RAPHAEL-PASKEY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ESOPUS
Mailing Address - State:NY
Mailing Address - Zip Code:12429
Mailing Address - Country:US
Mailing Address - Phone:845-384-6113
Mailing Address - Fax:
Practice Address - Street 1:112 N FRONT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3729
Practice Address - Country:US
Practice Address - Phone:845-338-5450
Practice Address - Fax:845-338-0949
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0703411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical