Provider Demographics
NPI:1861632804
Name:VAYNER, ANGELA (LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:VAYNER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:RISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:155 OCEANA DR E
Mailing Address - Street 2:APT 4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6684
Mailing Address - Country:US
Mailing Address - Phone:917-674-1828
Mailing Address - Fax:
Practice Address - Street 1:187 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3741
Practice Address - Country:US
Practice Address - Phone:917-674-1828
Practice Address - Fax:718-265-5309
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR072785-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical