Healthcare Provider Details

I. General information

NPI: 1104430370
Provider Name (Legal Business Name): RACHEL BEMIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 POST RD E
WESTPORT CT
06880-5679
US

IV. Provider business mailing address

5 STONELEIGH KNLS
OLD LYME CT
06371-1432
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8701
  • Fax:
Mailing address:
  • Phone: 774-258-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1908
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: