Provider Demographics
NPI:1023432291
Name:VODOPYANOV, MARGARITA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:
Last Name:VODOPYANOV
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4501
Mailing Address - Country:US
Mailing Address - Phone:917-755-9798
Mailing Address - Fax:
Practice Address - Street 1:29 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4501
Practice Address - Country:US
Practice Address - Phone:917-755-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2019-11-18
Deactivation Date:2018-05-29
Deactivation Code:
Reactivation Date:2019-11-18
Provider Licenses
StateLicense IDTaxonomies
NY091173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist