Provider Demographics
NPI:1972719250
Name:SITORSKY, MIRIAM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:SITORSKY
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 1:1714 46 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1211
Mailing Address - Country:US
Mailing Address - Phone:718-436-0449
Mailing Address - Fax:718-435-5543
Practice Address - Street 1:1714 46 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1211
Practice Address - Country:US
Practice Address - Phone:718-436-0449
Practice Address - Fax:718-435-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0466191104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1K601Medicare PIN