Provider Demographics
NPI:1164980512
Name:SENKEVICH, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SENKEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BRIGHTON BEACH AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5838
Mailing Address - Country:US
Mailing Address - Phone:718-637-3004
Mailing Address - Fax:
Practice Address - Street 1:2955 BRIGHTON 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8533
Practice Address - Country:US
Practice Address - Phone:718-332-0080
Practice Address - Fax:718-332-3365
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721128145171M00000X
171M00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator