Provider Demographics
NPI:1093728917
Name:ZEYLIKMAN, IRINA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:ZEYLIKMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4801
Mailing Address - Country:US
Mailing Address - Phone:917-208-4037
Mailing Address - Fax:917-332-5025
Practice Address - Street 1:1414 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1110
Practice Address - Country:US
Practice Address - Phone:917-208-4037
Practice Address - Fax:718-332-5025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0692671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7G261Medicare ID - Type Unspecified