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NPI Code Detail

MEDICARE: MICHELLE DENISE RAYSOR LMHC

MEDICARE: MICHELLE DENISE RAYSOR LMHC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor11804NY
2101YM0800XMental Health CounselorP99242NY

General Provider Information

NPI Number : 1801308804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DENISE RAYSOR LMHC
Provider Business Mailing Address
First Line : 654 MEADE AVE
Second Line :
City : BELLPORT
State : NY
Zip : 11713-1653
Country : US
Telephone Number : 631-394-1805
Fax Number :
Provider Business Practice Location Address
First Line : 1273 WILLIAM FLOYD PKWY
Second Line :
City : SHIRLEY
State : NY
Zip : 11967-1810
Country : US
Telephone Number : 631-394-1805
Fax Number : 631-887-3327
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2017
Last Update Date : 06/16/2018

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Directions to “ MICHELLE DENISE RAYSOR LMHC” Practice Location

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