Provider Demographics
NPI:1730354085
Name:BOU, RAFAEL ERIC (LCSW)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ERIC
Last Name:BOU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ROOSEVELT CT
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4135
Mailing Address - Country:US
Mailing Address - Phone:917-755-2425
Mailing Address - Fax:
Practice Address - Street 1:26 ROOSEVELT CT
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4135
Practice Address - Country:US
Practice Address - Phone:917-755-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health