Provider Demographics
NPI:1487076949
Name:RAYBIN, MARC (LCSW)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:RAYBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 KNIGHTSBRIDGE RD
Mailing Address - Street 2:APT 3I
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4540
Mailing Address - Country:US
Mailing Address - Phone:718-440-5475
Mailing Address - Fax:
Practice Address - Street 1:35 KNIGHTSBRIDGE RD
Practice Address - Street 2:APT 3I
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4540
Practice Address - Country:US
Practice Address - Phone:718-440-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730501781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical