Provider Demographics
NPI:1083816441
Name:KLYUCHNIKOVA, ALEKSANDRA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:KLYUCHNIKOVA
Suffix:
Gender:F
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:MS. A. KLYUCHNIKOVA
Mailing Address - Street 2:3107 EMMONS AVE, APT# 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-449-0182
Mailing Address - Fax:718-984-3683
Practice Address - Street 1:MS. A. KLYUCHNIKOVA
Practice Address - Street 2:3107 EMMONS AVE, 2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-449-0182
Practice Address - Fax:718-984-3683
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071644104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical