Provider Demographics
NPI:1063298230
Name:GUBENKO, IRINA (MFT)
Entity type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:GUBENKO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 NETHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1672
Mailing Address - Country:US
Mailing Address - Phone:646-246-7079
Mailing Address - Fax:
Practice Address - Street 1:3580 NETHERLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1672
Practice Address - Country:US
Practice Address - Phone:646-246-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist