Provider Demographics
NPI:1831490663
Name:MOGILEVSKAYA, INNA (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:INNA
Middle Name:
Last Name:MOGILEVSKAYA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SEACOAST TER APT 16S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6009
Mailing Address - Country:US
Mailing Address - Phone:718-415-3544
Mailing Address - Fax:718-415-3544
Practice Address - Street 1:35 SEACOAST TER APT 16S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6009
Practice Address - Country:US
Practice Address - Phone:718-415-3544
Practice Address - Fax:718-415-3544
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0770891041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831490663Medicaid