Provider Demographics
NPI:1710109228
Name:RABB, DAVID LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:RABB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STUYVESANT OVAL
Mailing Address - Street 2:APT 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2128
Mailing Address - Country:US
Mailing Address - Phone:917-776-0146
Mailing Address - Fax:212-777-8433
Practice Address - Street 1:80 EIGTH AVENUE
Practice Address - Street 2:1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:917-776-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050079-11041C0700X
NY15055691041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1J451Medicare ID - Type Unspecified