Active NPI
Ebony Deravariere
- Peer Specialist
- Schenectady, NY
National Provider Identifier
1669271029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 8552-P
- Practice address
- 600 Franklin St Ste 204
Schenectady, NY 12305-2107 - Phone
- (518) 372-7031
- Fax
- (518) 372-7064
- NPI assigned
- Mar 10, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 8552-P | NY | Primary |
Addresses
Primary practice location
600 Franklin St Ste 204
Schenectady, NY 12305-2107
Mailing address
1116 Pleasant St
Schenectady, NY 12303-1714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8552-P | NY | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conifer Park, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1741564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772496000000",
"number": "1669271029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1116 PLEASANT ST",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123031714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 FRANKLIN ST STE 204",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123052107",
"telephone_number": "518-372-7031",
"fax_number": "518-372-7064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERAVARIERE",
"first_name": "EBONY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-10",
"last_updated": "2026-03-03",
"certification_date": "2026-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NY",
"license": "8552-P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.