Healthcare Provider Details

I. General information

NPI: 1831298249
Provider Name (Legal Business Name): YELENA ZHUKLEVICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 NOSTRAND AVE STE.1E
BROOKLYN NY
11229-4056
US

IV. Provider business mailing address

354 VAN SICKLEN STREET 2C
BROOKLYN NY
11223
US

V. Phone/Fax

Practice location:
  • Phone: 917-674-9522
  • Fax: 718-764-1165
Mailing address:
  • Phone: 917-674-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP0622781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: