Basic Information
| Provider Information | |||||||||
| NPI: | 1174749188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUBOTIN | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | M.A., MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102-30 66TH RD | ||||||||
| Address2: | 3C | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113757616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177718623 | ||||||||
| FaxNumber: | 7188970095 | ||||||||
| Practice Location | |||||||||
| Address1: | 102-30 66 ROAD | ||||||||
| Address2: | 3C | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113757616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177718623 | ||||||||
| FaxNumber: | 7188970095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 002859 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.