Provider Demographics
NPI:1104308550
Name:KROTAVA, IRYNA (PHD)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:KROTAVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:IRYNA
Other - Middle Name:
Other - Last Name:KROTAVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:45 5TH AVE APT 7A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4387
Mailing Address - Country:US
Mailing Address - Phone:646-705-7757
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE STE 1004-5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:646-705-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical