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General NPI Number Information
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NPI Number | 1164726808
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Entity Type | Individual
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Provider Name | ANDRIY KOSTYNYUK LMHC, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 58 A MACKAY PL
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City | BROOKLYN
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State | NY
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Zip | 11209
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Country | US
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Telephone | 201-694-6245
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Fax |
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Provider Business Mailing Address
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Address Line | 470 LIBERTY ST APT 205
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City | LITTLE FERRY
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State | NJ
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Zip | 07643-1096
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Country | US
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Telephone | 201-694-6245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004666
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00610000
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License Number State | NJ
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