MEDICARE: DR. LAURA RABIN PH.D.

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	103TC0700X	Clinical Psychologist	0157671	NY

General Provider Information

NPI Number	:	1578655932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA RABIN PH.D.

Provider Business Mailing Address
First Line	:	59 WENSLEY DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1835
Country	:	US
Telephone Number	:	718-208-5332
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 WENSLEY DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1835
Country	:	US
Telephone Number	:	718-208-5332
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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