Provider Demographics
NPI:1942513080
Name:PRAVIKOVA, IRINA V (CASAC-T # 21593)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:PRAVIKOVA
Suffix:
Gender:F
Credentials:CASAC-T # 21593
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W 6TH ST
Mailing Address - Street 2:APT. # B6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4864
Mailing Address - Country:US
Mailing Address - Phone:718-292-6622
Mailing Address - Fax:718-292-2182
Practice Address - Street 1:260 E 161ST ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3512
Practice Address - Country:US
Practice Address - Phone:718-292-6622
Practice Address - Fax:718-292-2182
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor