MEDICARE: DIANA KOULIKOVA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	094719	NY

General Provider Information

NPI Number	:	1053736256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA KOULIKOVA LCSW

Provider Business Mailing Address
First Line	:	1855 E 12TH ST APT 3N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2775
Country	:	US
Telephone Number	:	718-312-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 86TH ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4440
Country	:	US
Telephone Number	:	347-391-4250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	05/26/2026

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