=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972013795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINOKUR PSYCHOTHERAPY LCSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2017
-----------------------------------------------------
Last Update Date | 03/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3320 AVENUE T
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-554-1518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 E 7TH ST APT 6N
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11218-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-554-1518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NONNA VINOKUR
-----------------------------------------------------
Credential | PSYCHOTHERAPIST
-----------------------------------------------------
Telephone | 347-554-1518
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------