Provider Demographics
NPI:1558333559
Name:RADOV, LYNN PAULETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:PAULETTE
Last Name:RADOV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:346 CONEY ISLAND AVE
Mailing Address - Street 2:101
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1804
Mailing Address - Country:US
Mailing Address - Phone:718-965-0273
Mailing Address - Fax:718-965-2381
Practice Address - Street 1:346 CONEY ISLAND AVE
Practice Address - Street 2:101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1804
Practice Address - Country:US
Practice Address - Phone:718-965-0273
Practice Address - Fax:718-965-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0322221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01475694Medicaid
NY01475694Medicaid