Healthcare Provider Details

I. General information

NPI: 1053736256
Provider Name (Legal Business Name): DIANA KOULIKOVA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 86TH ST FL 3
BROOKLYN NY
11214-4440
US

IV. Provider business mailing address

1855 E 12TH ST APT 3N
BROOKLYN NY
11229-2775
US

V. Phone/Fax

Practice location:
  • Phone: 347-391-4250
  • Fax:
Mailing address:
  • Phone: 718-312-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: