Rafael Castellanos
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Tupper Lake, NY
NPI 1720820657 · NPPES record last updated Mar 2, 2025
Key facts
- NPI
- 1720820657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 406090 (NY)
- Practice address
- 2445 State Route 30
Tupper Lake, NY 12986-2502 - Phone
- (518) 359-3311
- NPI assigned
- Jun 11, 2024
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250307000534 | NY | Order and Referring Only - Nurse Practitioner | 9931620887 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New York Comptrollers Office | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 406090 | NY | Yes |
Addresses
Primary practice location
2445 State Route 30
Tupper Lake, NY 12986-2502
Mailing address
2445 State Route 30
Tupper Lake, NY 12986-2502
Other providers in Tupper Lake, NY
- Darci Beiras
- Katie A Besig
- Deborah Anne Body
- Lorraine M Bowman
- Stephanie Cassell
- Kristen Nichole Churco
- Lisa Colbert
- Jules Comeau
- Vincent Connors
- Eileen Dattola
All providers in Tupper Lake, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.