Provider Demographics
NPI:1174543359
Name:RYBAK, CATHLEEN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:RYBAK
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 1:149 AVENUE A APT. 5FN
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009
Mailing Address - Country:US
Mailing Address - Phone:917-514-1908
Mailing Address - Fax:212-674-6774
Practice Address - Street 1:80 EAST 11TH STREET
Practice Address - Street 2:#534
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:917-514-1908
Practice Address - Fax:212-674-6774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048818-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical