Provider Demographics
NPI:1124124680
Name:MYZWINSKI, CHARLES (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:MYZWINSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PLAZA ST W
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3952
Mailing Address - Country:US
Mailing Address - Phone:718-622-0355
Mailing Address - Fax:
Practice Address - Street 1:45 PLAZA ST W
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3952
Practice Address - Country:US
Practice Address - Phone:718-622-0355
Practice Address - Fax:718-522-5828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR023926-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN17C01Medicare ID - Type Unspecified