Provider Demographics
NPI:1891895066
Name:LITROVNIK, INNA VALENTINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:INNA
Middle Name:VALENTINA
Last Name:LITROVNIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-2151
Mailing Address - Country:US
Mailing Address - Phone:718-676-4205
Mailing Address - Fax:718-676-4216
Practice Address - Street 1:182 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-2151
Practice Address - Country:US
Practice Address - Phone:718-676-4205
Practice Address - Fax:718-676-4216
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048258-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01650095Medicaid
NYLI801084Medicare ID - Type Unspecified