Provider Demographics
NPI:1881631141
Name:EFSTRATIADIS, LIANA (CSW)
Entity Type:Individual
Prefix:MISS
First Name:LIANA
Middle Name:
Last Name:EFSTRATIADIS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 21ST DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3936
Mailing Address - Country:US
Mailing Address - Phone:718-207-0006
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE 1709
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6129
Practice Address - Country:US
Practice Address - Phone:718-207-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062091-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062091-1OtherSTATE LICENSE