Provider Demographics
NPI:1679526172
Name:LADYZHENSKY, ALEX (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:LADYZHENSKY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1136
Mailing Address - Country:US
Mailing Address - Phone:718-449-9883
Mailing Address - Fax:
Practice Address - Street 1:3923 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1136
Practice Address - Country:US
Practice Address - Phone:718-449-9883
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053479-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02013629Medicaid
NY02013629Medicaid