Provider Demographics
NPI:1083727614
Name:SMUKLAVSKAYA, NINA (LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:SMUKLAVSKAYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ISABEL CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2227
Mailing Address - Country:US
Mailing Address - Phone:732-617-1087
Mailing Address - Fax:732-617-0652
Practice Address - Street 1:2327 83RD ST STE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2749
Practice Address - Country:US
Practice Address - Phone:732-236-0700
Practice Address - Fax:732-232-2526
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY54583601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical