Provider Demographics
NPI:1093740508
Name:SHIK, YELENA (R LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:SHIK
Suffix:
Gender:F
Credentials:R LCSW
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:MAZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 HEDGEROW LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2733
Mailing Address - Country:US
Mailing Address - Phone:631-374-5668
Mailing Address - Fax:631-493-4749
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 304
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-374-5668
Practice Address - Fax:631-499-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP 060751-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0285066Medicaid