Provider Demographics
NPI:1679873707
Name:DYADYUK, INNA (LSW)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:DYADYUK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4502
Mailing Address - Country:US
Mailing Address - Phone:917-535-9425
Mailing Address - Fax:
Practice Address - Street 1:9 GARWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4502
Practice Address - Country:US
Practice Address - Phone:917-535-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05652600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker