Provider Demographics
NPI:1154105609
Name:PRACTICAL ONLINE THERAPY LCSW PLLC
Entity type:Organization
Organization Name:PRACTICAL ONLINE THERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIXALY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-848-2237
Mailing Address - Street 1:45 ECKERT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3842
Mailing Address - Country:US
Mailing Address - Phone:347-848-2237
Mailing Address - Fax:
Practice Address - Street 1:10417 35TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1933
Practice Address - Country:US
Practice Address - Phone:347-848-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty