Provider Demographics
NPI:1801308804
Name:RAYSOR, MICHELLE DENISE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:RAYSOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1273 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1810
Practice Address - Country:US
Practice Address - Phone:631-394-1805
Practice Address - Fax:631-887-3327
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11804101YA0400X
NYP99242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)