Provider Demographics
NPI:1124474887
Name:PAYIATI- KONDOS, VASILIKI
Entity type:Individual
Prefix:
First Name:VASILIKI
Middle Name:
Last Name:PAYIATI- KONDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 YORK AVE
Mailing Address - Street 2:APT#4K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4030
Mailing Address - Country:US
Mailing Address - Phone:646-610-0800
Mailing Address - Fax:
Practice Address - Street 1:1360 YORK AVE
Practice Address - Street 2:APT#4K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4030
Practice Address - Country:US
Practice Address - Phone:646-610-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0970901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical