Provider Demographics
NPI:1194573865
Name:EGUABOR, DARLIE GIOVANNIE
Entity type:Individual
Prefix:
First Name:DARLIE
Middle Name:GIOVANNIE
Last Name:EGUABOR
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 1:911 E 229TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4659
Mailing Address - Country:US
Mailing Address - Phone:917-843-7172
Mailing Address - Fax:
Practice Address - Street 1:911 E 229TH ST APT 2R
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4659
Practice Address - Country:US
Practice Address - Phone:917-843-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst