Provider Demographics
NPI:1851364582
Name:LABRAKE, TAMMY J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:J
Last Name:LABRAKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4531
Mailing Address - Country:US
Mailing Address - Phone:518-786-6993
Mailing Address - Fax:
Practice Address - Street 1:409 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5502
Practice Address - Country:US
Practice Address - Phone:518-786-6993
Practice Address - Fax:518-786-6943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0409141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical