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General NPI Number Information
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NPI Number | 1053516435
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Entity Type | Individual
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Provider Name | RAPHEL COBB SOCIAL WORKERL.M.S.W
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 42 N MAIN ST
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City | LIBERTY
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State | NY
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Zip | 12754-1860
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Country | US
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Telephone | 845-292-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 42 N MAIN ST
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City | LIBERTY
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State | NY
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Zip | 12754-1860
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Country | US
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Telephone | 845-292-1230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 071573-1
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License Number State | NY
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