Provider Demographics
NPI:1922105931
Name:MOSKIN, ILENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:MOSKIN
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 1:405 W 57TH ST
Mailing Address - Street 2:#6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1721
Mailing Address - Country:US
Mailing Address - Phone:212-246-8519
Mailing Address - Fax:
Practice Address - Street 1:2020 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2329
Practice Address - Country:US
Practice Address - Phone:718-676-4222
Practice Address - Fax:718-676-4216
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040101-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9A591Medicare ID - Type Unspecified