Provider Demographics
NPI:1740029677
Name:DRAHAIM, EDYTA
Entity type:Individual
Prefix:
First Name:EDYTA
Middle Name:
Last Name:DRAHAIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 105TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4786
Mailing Address - Country:US
Mailing Address - Phone:646-832-9068
Mailing Address - Fax:
Practice Address - Street 1:1841 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1316
Practice Address - Country:US
Practice Address - Phone:646-459-6091
Practice Address - Fax:646-459-6088
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108516-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker