Provider Demographics
NPI:1558738831
Name:CONNECTING FOR PURPOSE
Entity Type:Organization
Organization Name:CONNECTING FOR PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MENTAL HEALTH COUNEL
Authorized Official - Phone:631-394-1805
Mailing Address - Street 1:654 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-1653
Mailing Address - Country:US
Mailing Address - Phone:631-394-1805
Mailing Address - Fax:
Practice Address - Street 1:654 MEADE AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1653
Practice Address - Country:US
Practice Address - Phone:631-394-1805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00073712251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable