Provider Demographics
NPI:1851974174
Name:GURKOVSKY, RADMILA (LCAT-LP, ATR-P)
Entity Type:Individual
Prefix:
First Name:RADMILA
Middle Name:
Last Name:GURKOVSKY
Suffix:
Gender:F
Credentials:LCAT-LP, ATR-P
Other - Prefix:
Other - First Name:RADMILA
Other - Middle Name:
Other - Last Name:GURKOVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT-LP, ATR-P
Mailing Address - Street 1:96 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2518
Mailing Address - Country:US
Mailing Address - Phone:917-535-0430
Mailing Address - Fax:
Practice Address - Street 1:96 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2518
Practice Address - Country:US
Practice Address - Phone:917-535-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104057-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist