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General NPI Number Information
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NPI Number | 1700819398
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Entity Type | Individual
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Provider Name | YAKOV PUKHOVICH LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 2925A KINGS HWY
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City | BROOKLYN
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State | NY
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Zip | 11229-1805
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Country | US
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Telephone | 718-382-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 1143 SHORE PRKW.
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City | BROOKLYN
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State | NY
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Zip | 11214
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Country | US
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Telephone | 917-885-8701
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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 | 078514
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License Number State | NY
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