Provider Demographics
NPI:1396975538
Name:ONDRICEK, JUSTINE SUE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:SUE
Last Name:ONDRICEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:SUE
Other - Last Name:HAJJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 EAST 94TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2510
Mailing Address - Country:US
Mailing Address - Phone:914-255-3258
Mailing Address - Fax:212-256-0275
Practice Address - Street 1:45 POPHAM RD,
Practice Address - Street 2:SUITE 1F,
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-255-3258
Practice Address - Fax:212-256-0275
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025106-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13253POtherHIP