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General NPI Number Information
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NPI Number | 1518404946
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Entity Type | Individual
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Provider Name | ELLA KREYDINA LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 157 13TH ST
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City | BROOKLYN
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State | NY
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Zip | 11215-4702
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Country | US
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Telephone | 917-740-0061
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Fax |
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Provider Business Mailing Address
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Address Line | 157 13TH ST
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City | BROOKLYN
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State | NY
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Zip | 11215-4702
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Country | US
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Telephone | 917-740-0061
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 090417
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 095630
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License Number State | NY
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