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General NPI Number Information
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NPI Number | 1699663120
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Entity Type | Organization
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Legal Business Name | K. KABANOVICH LCSW P.C.
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 31 BIANCA CT
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6621
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Country | US
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Telephone | 917-586-1083
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Fax | 917-586-1083
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Provider Business Mailing Address
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Address Line | 31 BIANCA CT
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6621
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Country | US
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Telephone | 917-586-1083
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Fax | 917-586-1083
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATSIARYNA KABANOVICH
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Credential |
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Telephone | 917-586-1083
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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 |
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License Number State |
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