Individual
RAY ALI TEBOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
2976 NORTHERN BLVD, LONG ISLAND CITY, NY 11101-2822
(646) 807-8886
Mailing address
2976 NORTHERN BLVD, LONG ISLAND CITY, NY 11101-2822
(646) 807-8886
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
26665
NY
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/13/2008
Last updated
01/16/2012
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