Provider Demographics
NPI:1760676720
Name:SREBNICK, JOSHUA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:M
Last Name:SREBNICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MONTAGUE ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3343
Mailing Address - Country:US
Mailing Address - Phone:917-859-3974
Mailing Address - Fax:
Practice Address - Street 1:65 MONTAGUE ST APT 4C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3343
Practice Address - Country:US
Practice Address - Phone:917-859-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical