Provider Demographics
NPI:1649985003
Name:MYSLIVECEK, ABIGAL J (LMSW)
Entity type:Individual
Prefix:
First Name:ABIGAL
Middle Name:J
Last Name:MYSLIVECEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 MANITOU RD APT 3
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1177
Mailing Address - Country:US
Mailing Address - Phone:585-406-6141
Mailing Address - Fax:
Practice Address - Street 1:21 WILLOW POND WAY STE 103
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-385-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker