Basic Information
| Provider Information | |||||||||
| NPI: | 1306140645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVRENTIEV | ||||||||
| FirstName: | NATALIA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 E 18TH ST | ||||||||
| Address2: | APT 2G | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112307558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473746565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | 5A-216 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638396 | ||||||||
| FaxNumber: | 7186303138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2010 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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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 | 1041C0700X | 069730 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.