Provider Demographics
NPI:1831489178
Name:NISONOVA, YULIYA M (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:YULIYA
Middle Name:M
Last Name:NISONOVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E 18TH ST
Mailing Address - Street 2:# A1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5343
Mailing Address - Country:US
Mailing Address - Phone:718-564-4989
Mailing Address - Fax:
Practice Address - Street 1:2792 OCEAN AVE FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4730
Practice Address - Country:US
Practice Address - Phone:718-332-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082978-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker