Provider Demographics
NPI:1104994763
Name:MESHCHERYAKOVA, KSENIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KSENIA
Middle Name:
Last Name:MESHCHERYAKOVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 W 2ND ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1624
Mailing Address - Country:US
Mailing Address - Phone:718-645-5677
Mailing Address - Fax:718-645-5430
Practice Address - Street 1:1628 W 2ND ST
Practice Address - Street 2:1 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1624
Practice Address - Country:US
Practice Address - Phone:718-645-5677
Practice Address - Fax:718-645-5430
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN 0817041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical