Provider Demographics
NPI:1750508354
Name:PRYBUTOK, DENA (LCSW)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:PRYBUTOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E 56TH ST
Mailing Address - Street 2:APT. 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3623
Mailing Address - Country:US
Mailing Address - Phone:646-221-7873
Mailing Address - Fax:516-759-9883
Practice Address - Street 1:32 UNION SQ E
Practice Address - Street 2:SUITE 805
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:646-221-7873
Practice Address - Fax:516-759-9883
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0692281-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0692281-1OtherLICENSE NUMBER
NYP3602059OtherOXFORD HEALTH INSURANCE