Individual
JOSE RAFAEL CARRASQUILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2155 MAIN ST, SPRINGFIELD, MA 01104-3301
(413) 736-0395
Mailing address
2155 MAIN ST, SPRINGFIELD, MA 01104-3301
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042622756
CCA
MA
01
—
1134107113
BEACON
MA
05
—
1134107113
—
MA
01
—
12529
HNE
MA
01
—
71756
TUFTS
MA
01
—
997303
NETWORK HEALTH
MA
01
—
Y10086
MEDICARE
MA
Enumeration date
09/11/2017
Last updated
09/11/2017
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