Provider Demographics
NPI:1700409521
Name:SOSHKIN, TATYANA (CASAC)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:SOSHKIN
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 72ND RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4600
Mailing Address - Country:US
Mailing Address - Phone:718-262-3437
Mailing Address - Fax:
Practice Address - Street 1:11215 72ND RD STE LL1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4600
Practice Address - Country:US
Practice Address - Phone:718-262-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty