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General NPI Number Information
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NPI Number | 1710107735
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Entity Type | Individual
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Provider Name | SVYATOSLAV BAKIS LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 745 64TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-4753
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Country | US
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Telephone | 718-283-1913
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Fax | 718-635-6745
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Provider Business Mailing Address
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Address Line | 355 MALLORY AVE B
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4200
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Country | US
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Telephone | 718-876-6226
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 052698-1
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License Number State | NY
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