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Organization

CONNECTING FOR PURPOSE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MICHELLE RAYSOR MENTAL HEALTH COUNEL (EXECUTIVE DIRECTOR)
(631) 394-1805
Entity
Organization

Contact information

Practice address
654 MEADE AVE, BELLPORT, NY 11713-1653
(631) 394-1805
Mailing address
654 MEADE AVE, BELLPORT, NY 11713-1653
(631) 394-1805

Taxonomy

Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
00073712
NY

Other

Enumeration date
08/21/2015
Last updated
08/21/2015
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