MEDICARE: RAVEN EASTORIA CLINTON MFT

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	106H00000X	Marriage & Family Therapist		NY

General Provider Information

NPI Number	:	1760325245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN EASTORIA CLINTON MFT

Provider Business Mailing Address
First Line	:	41 SCHERMERHORN ST, BROOKLYN, NY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 SCHERMERHORN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4802
Country	:	US
Telephone Number	:	347-752-2233
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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