Provider Demographics
NPI:1831298249
Name:ZHUKLEVICH, YELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:ZHUKLEVICH
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 1:354 VAN SICKLEN STREET
Mailing Address - Street 2:2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:917-674-9522
Mailing Address - Fax:
Practice Address - Street 1:3380 NOSTRAND AVE
Practice Address - Street 2:STE.1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4056
Practice Address - Country:US
Practice Address - Phone:917-674-9522
Practice Address - Fax:718-764-1165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0622781104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS5381Medicare PIN