Provider Demographics
NPI:1720369242
Name:SLIZESKI, RICHARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:SLIZESKI
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 1:1900B RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5302
Mailing Address - Country:US
Mailing Address - Phone:347-409-8784
Mailing Address - Fax:718-253-8590
Practice Address - Street 1:1900B RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5302
Practice Address - Country:US
Practice Address - Phone:347-409-8784
Practice Address - Fax:718-253-8590
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker