Provider Demographics
NPI:1598361487
Name:NATALIYA PANCHENKO LCSW
Entity Type:Organization
Organization Name:NATALIYA PANCHENKO LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:NATALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-539-8689
Mailing Address - Street 1:851 CHERRY AVE STE 27406
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2900
Mailing Address - Country:US
Mailing Address - Phone:650-539-8689
Mailing Address - Fax:650-636-9434
Practice Address - Street 1:851 CHERRY AVE STE 27406
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2900
Practice Address - Country:US
Practice Address - Phone:650-539-8689
Practice Address - Fax:650-636-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1234567OtherUNKNOWN