Healthcare Provider Details

I. General information

NPI: 1619433422
Provider Name (Legal Business Name): RAYON LENNON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 02/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WHITNEY AVE
HAMDEN CT
06517-2499
US

IV. Provider business mailing address

358 EDGEWOOD AVE APT 2
NEW HAVEN CT
06511-4082
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-2116
  • Fax:
Mailing address:
  • Phone: 203-507-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010501
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: