Organization
SUPPORTIVE CARE OF WYOMING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL LICHTSCHEIN (PRESIDENT)
(718) 298-4375
Entity
Organization
Contact information
Practice address
2700 E 12TH ST, CHEYENNE, WY 82001-5604
(718) 506-1115
Mailing address
27 RANDOLPH RD, HOWELL, NJ 07731-8611
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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