Provider Demographics
NPI:1811035264
Name:KLUSNER, VICTOR M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:M
Last Name:KLUSNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:51 HAMPTON PL
Mailing Address - Street 2:17G
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5817
Mailing Address - Country:US
Mailing Address - Phone:516-378-7156
Mailing Address - Fax:
Practice Address - Street 1:1908 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3626
Practice Address - Country:US
Practice Address - Phone:718-869-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO16780-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS61058Medicare UPIN