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General NPI Number Information
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NPI Number | 1578413167
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE CARE OF WYOMING LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 2700 E 12TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-5604
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Country | US
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Telephone | 718-506-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 27 RANDOLPH RD
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City | HOWELL
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State | NJ
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Zip | 07731-8611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAPHAEL LICHTSCHEIN
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Credential |
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Telephone | 718-298-4375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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