Provider Demographics
NPI:1073265674
Name:RAINEY, EMMALEE A (LMSW)
Entity Type:Individual
Prefix:
First Name:EMMALEE
Middle Name:A
Last Name:RAINEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 E 120TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3013
Mailing Address - Country:US
Mailing Address - Phone:601-594-6669
Mailing Address - Fax:
Practice Address - Street 1:239 E 120TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3013
Practice Address - Country:US
Practice Address - Phone:973-294-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY114928OtherSOCIAL WORK LICENSE #