Provider Demographics
NPI:1295188076
Name:IV LICENSED CLINICAL SOCIAL WORK P.C.
Entity Type:Organization
Organization Name:IV LICENSED CLINICAL SOCIAL WORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSKOBOYNIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-288-4770
Mailing Address - Street 1:4812 BEDFORD AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8603
Mailing Address - Country:US
Mailing Address - Phone:718-234-1212
Mailing Address - Fax:
Practice Address - Street 1:4812 BEDFORD AVE
Practice Address - Street 2:APT 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8603
Practice Address - Country:US
Practice Address - Phone:718-234-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069657261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health