Healthcare Provider Details

I. General information

NPI: 1649356437
Provider Name (Legal Business Name): YELENA REPKA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 48TH ST
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

298 FINLEY AVE
STATEN ISLAND NY
10306-5658
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074121-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: