Provider Demographics
NPI:1457574550
Name:KIZHNER, REBECCA H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:H
Last Name:KIZHNER
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 1:9050 UNION TPKE
Mailing Address - Street 2:APT. 15K
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8002
Mailing Address - Country:US
Mailing Address - Phone:516-662-3922
Mailing Address - Fax:
Practice Address - Street 1:13718 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1989
Practice Address - Country:US
Practice Address - Phone:516-662-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0823901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical