Provider Demographics
NPI:1740804053
Name:MACIERAKOWSKA, OLENA
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:MACIERAKOWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NEW DORP PLZ S STE 210
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2902
Mailing Address - Country:US
Mailing Address - Phone:917-703-5024
Mailing Address - Fax:
Practice Address - Street 1:88 NEW DORP PLZ S STE 210
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2902
Practice Address - Country:US
Practice Address - Phone:917-703-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health