Healthcare Provider Details

I. General information

NPI: 1750508354
Provider Name (Legal Business Name): DENA PRYBUTOK L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 UNION SQ E SUITE 805
NEW YORK NY
10003-3209
US

IV. Provider business mailing address

140 E 56TH ST APT. 6D
NEW YORK NY
10022-3623
US

V. Phone/Fax

Practice location:
  • Phone: 646-221-7873
  • Fax: 516-759-9883
Mailing address:
  • Phone: 646-221-7873
  • Fax: 516-759-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0692281-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: