Provider Demographics
NPI:1275388316
Name:RAFFERTY, PATRICK JEREMIAH (MSW, LSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JEREMIAH
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CARDINAL DR STE 280
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6598
Mailing Address - Country:US
Mailing Address - Phone:847-214-0070
Mailing Address - Fax:
Practice Address - Street 1:300 CARDINAL DR STE 280
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6598
Practice Address - Country:US
Practice Address - Phone:847-214-0070
Practice Address - Fax:331-269-2106
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health