Provider Demographics
NPI:1154571396
Name:BORISKIN, LEA M (LCSW)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:M
Last Name:BORISKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:M
Other - Last Name:GREENSPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10819 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1034
Mailing Address - Country:US
Mailing Address - Phone:718-845-2620
Mailing Address - Fax:718-845-9380
Practice Address - Street 1:10819 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1034
Practice Address - Country:US
Practice Address - Phone:718-845-2620
Practice Address - Fax:718-845-9380
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0786171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00078617Medicaid