Provider Demographics
NPI:1710865589
Name:RAFAILOV, KATRIN (EDM, MA)
Entity type:Individual
Prefix:
First Name:KATRIN
Middle Name:
Last Name:RAFAILOV
Suffix:
Gender:F
Credentials:EDM, MA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:RAFAILOV SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:162 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2306
Mailing Address - Country:US
Mailing Address - Phone:718-704-8967
Mailing Address - Fax:
Practice Address - Street 1:1200 S ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4328
Practice Address - Country:US
Practice Address - Phone:718-704-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool