Healthcare Provider Details

I. General information

NPI: 1205917655
Provider Name (Legal Business Name): LYNN B RAKOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI 1635 CENTRAL AVENUE
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

SOUTHWEST CT MENTAL HEALTH SYSTEM ATTN SANDRA GRAZYNSKI 1635 CENTRAL AVENUE ROOM 213
BRIDGEPORT CT
06610
US

V. Phone/Fax

Practice location:
  • Phone: 203-551-7660
  • Fax: 203-551-7481
Mailing address:
  • Phone: 203-551-7660
  • Fax: 203-551-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number002388
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number002388
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: