Provider Demographics
NPI:1922352590
Name:TARTSAKOV, VLADA (MSWB)
Entity Type:Individual
Prefix:MRS
First Name:VLADA
Middle Name:
Last Name:TARTSAKOV
Suffix:
Gender:F
Credentials:MSWB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6302
Mailing Address - Country:US
Mailing Address - Phone:212-219-5400
Mailing Address - Fax:
Practice Address - Street 1:7813 153RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1771
Practice Address - Country:US
Practice Address - Phone:718-374-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6828911211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08EI124711R1X00OtherCITY PRO GROUP INC