Healthcare Provider Details

I. General information

NPI: 1255875720
Provider Name (Legal Business Name): OLGA KUHARENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 12/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 48TH ST
BROOKLYN NY
11219-2919
US

IV. Provider business mailing address

929 48TH ST
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 347-855-2676
  • Fax:
Mailing address:
  • Phone: 347-855-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72098360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: