Provider Demographics
NPI:1972353043
Name:FITENKO, YULIA
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:FITENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 AVENUE S APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2931
Mailing Address - Country:US
Mailing Address - Phone:646-884-4479
Mailing Address - Fax:
Practice Address - Street 1:387 AVENUE S APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2931
Practice Address - Country:US
Practice Address - Phone:646-884-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001191103TP0814X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis