MEDICARE: MS. RAINA LAREN BRABOY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	076175-1	NY

General Provider Information

NPI Number	:	1407902711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAINA LAREN BRABOY LCSW

Provider Business Mailing Address
First Line	:	1110 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-5375
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-5375
Country	:	US
Telephone Number	:	718-860-2515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/13/2023

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