Provider Demographics
NPI:1649677790
Name:VASILCHENKO, IRINA (LCSW)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:VASILCHENKO
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 1:225 E 86TH ST
Mailing Address - Street 2:APT 803
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3019
Mailing Address - Country:US
Mailing Address - Phone:646-707-8005
Mailing Address - Fax:
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE C5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:212-844-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker