Provider Demographics
NPI:1306364641
Name:RAFFETY, JOAN LEIGH
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LEIGH
Last Name:RAFFETY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S 84TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2600
Mailing Address - Country:US
Mailing Address - Phone:402-261-9273
Mailing Address - Fax:402-261-9274
Practice Address - Street 1:245 S 84TH ST STE 212
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2600
Practice Address - Country:US
Practice Address - Phone:402-261-9273
Practice Address - Fax:402-261-9274
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7188101YM0800X
NE11281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health