Provider Demographics
NPI:1063838548
Name:KONTAROVICH, OLEG (LMSW)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:KONTAROVICH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24021 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1928
Mailing Address - Country:US
Mailing Address - Phone:718-809-1024
Mailing Address - Fax:718-428-3231
Practice Address - Street 1:24021 68TH AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1928
Practice Address - Country:US
Practice Address - Phone:718-809-1024
Practice Address - Fax:718-428-3231
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7221031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker