Provider Demographics
NPI:1467595801
Name:KRUPNICK, SIVAN GAL (LCSW)
Entity Type:Individual
Prefix:
First Name:SIVAN
Middle Name:GAL
Last Name:KRUPNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 136TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1627
Mailing Address - Country:US
Mailing Address - Phone:917-531-7148
Mailing Address - Fax:
Practice Address - Street 1:6933 136TH ST APT A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1627
Practice Address - Country:US
Practice Address - Phone:917-531-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075319-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical