Provider Demographics
NPI:1174748859
Name:VAYNRUB, YULIYA (LCSW)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:VAYNRUB
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 1:853 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3111
Mailing Address - Country:US
Mailing Address - Phone:917-657-0290
Mailing Address - Fax:
Practice Address - Street 1:853 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3111
Practice Address - Country:US
Practice Address - Phone:917-657-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074671-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1R761Medicare UPIN