Provider Demographics
NPI:1992889158
Name:WISANSKY, KARIN FAY (LCSW)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:FAY
Last Name:WISANSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TZIPPORAH
Other - Middle Name:KARIN
Other - Last Name:WISANSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1273 53RD ST
Mailing Address - Street 2:JBFCS 4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3845
Mailing Address - Country:US
Mailing Address - Phone:718-435-5700
Mailing Address - Fax:
Practice Address - Street 1:1273 53RD ST
Practice Address - Street 2:JBFCS 4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3845
Practice Address - Country:US
Practice Address - Phone:718-435-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077238-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical