Provider Demographics
NPI:1558890988
Name:SIMIDCHIEVA, IRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SIMIDCHIEVA
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 1:6210 99TH ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1481
Mailing Address - Country:US
Mailing Address - Phone:917-745-3455
Mailing Address - Fax:
Practice Address - Street 1:6210 99TH STREET
Practice Address - Street 2:APT.6A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:917-717-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker