Healthcare Provider Details

I. General information

NPI: 1710109228
Provider Name (Legal Business Name): DAVID LAWRENCE RABB LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EIGTH AVENUE 1108
NEW YORK NY
10011
US

IV. Provider business mailing address

3 STUYVESANT OVAL APT 6D
NEW YORK NY
10009-2128
US

V. Phone/Fax

Practice location:
  • Phone: 917-776-0146
  • Fax:
Mailing address:
  • Phone: 917-776-0146
  • Fax: 212-777-8433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR050079-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1505569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: