Provider Demographics
NPI:1144894908
Name:RABOY, DARA R (LCSW-R)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:R
Last Name:RABOY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 LYNDALE DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2439
Mailing Address - Country:US
Mailing Address - Phone:607-621-2068
Mailing Address - Fax:
Practice Address - Street 1:3619 LYNDALE DR
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-2439
Practice Address - Country:US
Practice Address - Phone:607-621-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0442551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR024255OtherNYS BOARD