Provider Demographics
NPI:1932270808
Name:PROFIS, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:PROFIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:PROFIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:130 FRANKLIN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1204
Mailing Address - Country:US
Mailing Address - Phone:718-614-7355
Mailing Address - Fax:
Practice Address - Street 1:130 FRANKLIN AVE FL 1
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1204
Practice Address - Country:US
Practice Address - Phone:718-614-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0573851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00057385Medicaid
NY00057385Medicaid