Healthcare Provider Details

I. General information

NPI: 1538344015
Provider Name (Legal Business Name): DENISE RABOIN LICSW, CEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SYLVAN ST
DANVERS MA
01923-3564
US

IV. Provider business mailing address

20 JUNIPER AVE
SALEM MA
01970-5723
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7570
  • Fax:
Mailing address:
  • Phone: 978-744-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: