Provider Demographics
NPI:1689857583
Name:LUSHIN, VICTOR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:LUSHIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 AVENUE V APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4525
Mailing Address - Country:US
Mailing Address - Phone:718-743-7331
Mailing Address - Fax:
Practice Address - Street 1:1820 AVENUE V APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4525
Practice Address - Country:US
Practice Address - Phone:718-743-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker