Provider Demographics
NPI:1467132100
Name:RUBANAVA, LIDZIYA (LMSW)
Entity Type:Individual
Prefix:
First Name:LIDZIYA
Middle Name:
Last Name:RUBANAVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LIDA
Other - Middle Name:
Other - Last Name:RUBANAVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4314 34TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1149
Mailing Address - Country:US
Mailing Address - Phone:224-399-7940
Mailing Address - Fax:
Practice Address - Street 1:131 W 33RD ST STE 11B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2939
Practice Address - Country:US
Practice Address - Phone:973-302-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1204371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical