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General NPI Number Information
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NPI Number | 1518339449
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Entity Type | Individual
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Provider Name | SVETLANA BURYAKOV LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1329 EAST 17TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone | 718-382-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 509 SANDRA PLACE
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City | BRICK
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State | NJ
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Zip | 08724
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Country | US
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Telephone | 917-501-2667
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05866500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082772-1
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License Number State | NY
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