Provider Demographics
NPI:1114596129
Name:MAKAROVA, KSENIA (LMSW)
Entity Type:Individual
Prefix:
First Name:KSENIA
Middle Name:
Last Name:MAKAROVA
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 1:53 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1293
Mailing Address - Country:US
Mailing Address - Phone:845-857-6826
Mailing Address - Fax:
Practice Address - Street 1:400 W 37TH ST APT 10F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5630
Practice Address - Country:US
Practice Address - Phone:845-857-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104284-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker