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NPI Code Detail

MEDICARE: RAPHA BEHAVIORAL SERVICES LLC

MEDICARE: RAPHA BEHAVIORAL SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1487125456
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAPHA BEHAVIORAL SERVICES LLC
Provider Business Mailing Address
First Line : 925 SULLIVAN AVE STE 2
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2080
Country : US
Telephone Number : 860-432-7771
Fax Number :
Provider Business Practice Location Address
First Line : 925 SULLIVAN AVE STE 2
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2080
Country : US
Telephone Number : 860-432-7771
Fax Number :
Authorized Official
Title or Position : SOLE MEMBER
Name : WILLIAM A ABROKWA
Credential : APN
Telephone Number : 860-432-7771
Provider Enumeration Date : 12/16/2018
Last Update Date : 12/16/2018

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Directions to “RAPHA BEHAVIORAL SERVICES LLC ” Practice Location

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