Provider Demographics
NPI:1497710560
Name:PYSKACEK, NAYA (LICSW)
Entity Type:Individual
Prefix:
First Name:NAYA
Middle Name:
Last Name:PYSKACEK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BAYCREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7713
Mailing Address - Country:US
Mailing Address - Phone:802-999-9999
Mailing Address - Fax:
Practice Address - Street 1:3 BAYCREST DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7713
Practice Address - Country:US
Practice Address - Phone:802-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900008991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009231OtherFLETCHER ALLEN PREFERRED
576749OtherVALUE OPTIONS
VT2278542OtherCIGNA BEHAVIORAL HEALTH
VT68204OtherBLUE CROSS BLUE SHIELD
VT68204OtherVERMONT MANAGED CARE
VT1009231Medicaid
VT1009231OtherFLETCHER ALLEN PREFERRED