Provider Demographics
NPI:1881778728
Name:ITSKOVICH, YEVGENIY EUGENE (MSW)
Entity type:Individual
Prefix:MR
First Name:YEVGENIY
Middle Name:EUGENE
Last Name:ITSKOVICH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 AVENUE L
Mailing Address - Street 2:#2 H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:917-428-1071
Mailing Address - Fax:718-377-7455
Practice Address - Street 1:1819 AVENUE L
Practice Address - Street 2:#2 H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:917-428-1071
Practice Address - Fax:718-377-7455
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07332611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical