Provider Demographics
NPI:1205936986
Name:CHERNAVSKY, MARINA (LCSW)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:CHERNAVSKY
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 1:32 MAY PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4123
Mailing Address - Country:US
Mailing Address - Phone:917-597-7399
Mailing Address - Fax:
Practice Address - Street 1:2059 OCEAN AVE APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7344
Practice Address - Country:US
Practice Address - Phone:917-597-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0650181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7L891Medicare ID - Type Unspecified