Provider Demographics
NPI:1477673390
Name:MOHEBAN, RACHEL Y (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:Y
Last Name:MOHEBAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BLEECKER ST
Mailing Address - Street 2:APT. 513
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1547
Mailing Address - Country:US
Mailing Address - Phone:917-273-8836
Mailing Address - Fax:
Practice Address - Street 1:77 BLEECKER ST
Practice Address - Street 2:APT. 513
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1547
Practice Address - Country:US
Practice Address - Phone:917-273-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical