Provider Demographics
NPI:1760254916
Name:RAPHA MIND & BODY, LLC
Entity Type:Organization
Organization Name:RAPHA MIND & BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-500-3119
Mailing Address - Street 1:22 HAPPY HOLLOW CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8411
Mailing Address - Country:US
Mailing Address - Phone:917-975-1822
Mailing Address - Fax:
Practice Address - Street 1:3 ARMSTRONG RD # 1102
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4706
Practice Address - Country:US
Practice Address - Phone:516-500-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health