Provider Demographics
NPI:1689484479
Name:RAFFERTY, KYLE JAMES
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 STARKEY RD UNIT 10401
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2481
Mailing Address - Country:US
Mailing Address - Phone:978-888-4413
Mailing Address - Fax:
Practice Address - Street 1:960 STARKEY RD UNIT 10401
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2481
Practice Address - Country:US
Practice Address - Phone:978-888-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician