Individual
EBONY DERAVARIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 FRANKLIN ST STE 204, SCHENECTADY, NY 12305-2107
(518) 372-7031
(518) 372-7064
Mailing address
1116 PLEASANT ST, SCHENECTADY, NY 12303-1714
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
8552-P
NY
Other
Enumeration date
03/10/2025
Last updated
03/03/2026
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