Provider Demographics
NPI:1306140645
Name:LAVRENTIEV, NATALIA (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:LAVRENTIEV
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 1:1355 E 18TH ST
Mailing Address - Street 2:APT 2G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7558
Mailing Address - Country:US
Mailing Address - Phone:347-374-6565
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:5A-216
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8396
Practice Address - Fax:718-630-3138
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0697301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical