Provider Demographics
NPI:1043863343
Name:BAKSHEEVA, EKATERINA
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:BAKSHEEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:BAKSHEEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:8792 16TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5802
Mailing Address - Country:US
Mailing Address - Phone:347-320-9793
Mailing Address - Fax:
Practice Address - Street 1:8792 16TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5802
Practice Address - Country:US
Practice Address - Phone:347-320-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104467-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty