Provider Demographics
NPI:1225771074
Name:OSTAPENKO, DMITRIY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DMITRIY
Middle Name:
Last Name:OSTAPENKO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:DMITRIY
Other - Middle Name:
Other - Last Name:OSTAPENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1815 E 17TH ST APT 6L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2937
Mailing Address - Country:US
Mailing Address - Phone:718-219-2281
Mailing Address - Fax:
Practice Address - Street 1:1815 E 17TH ST APT 6L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2937
Practice Address - Country:US
Practice Address - Phone:718-219-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1059191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical