Provider Demographics
NPI:1306070412
Name:RABAEV, GOLDIE (LPC)
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:
Last Name:RABAEV
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AUER CT
Mailing Address - Street 2:SUIT D
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5828
Mailing Address - Country:US
Mailing Address - Phone:937-964-5779
Mailing Address - Fax:732-390-0017
Practice Address - Street 1:6 AUER CT
Practice Address - Street 2:SUIT D
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:937-964-5779
Practice Address - Fax:732-390-0017
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
NJ37PC00394000101YP2500X
NY002598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health