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General NPI Number Information
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NPI Number | 1578525234
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Entity Type | Individual
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Provider Name | OLEG SIROTNIKOV LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 101 DARTMOUTH ST
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3215
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Country | US
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Telephone | 516-295-2659
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Fax | 516-295-2659
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Provider Business Mailing Address
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Address Line | 101 DARTMOUTH ST
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3215
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Country | US
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Telephone | 516-295-2659
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Fax | 516-295-2659
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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 | P058840
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License Number State | NY
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