Healthcare Provider Details

I. General information

NPI: 1013466002
Provider Name (Legal Business Name): MAKSIM KREYNGOLD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 AMSTERDAM AVE
NEW YORK NY
10031-1716
US

IV. Provider business mailing address

108 W 39TH ST RM 1006
NEW YORK NY
10018-8265
US

V. Phone/Fax

Practice location:
  • Phone: 323-497-0980
  • Fax:
Mailing address:
  • Phone: 323-497-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082880
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: