Provider Demographics
NPI:1124663745
Name:EUBANKS, EMMETT RHETT (LCSW)
Entity type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:RHETT
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELIZABETH
Other - Last Name:EUBANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3967 STATE ROUTE 149
Mailing Address - Street 2:
Mailing Address - City:FORT ANN
Mailing Address - State:NY
Mailing Address - Zip Code:12827-4103
Mailing Address - Country:US
Mailing Address - Phone:518-417-2381
Mailing Address - Fax:
Practice Address - Street 1:3967 STATE ROUTE 149
Practice Address - Street 2:
Practice Address - City:FORT ANN
Practice Address - State:NY
Practice Address - Zip Code:12827-4103
Practice Address - Country:US
Practice Address - Phone:518-417-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0960621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical