Provider Demographics
NPI:1174749188
Name:SUBOTIN, INNA (MA, MSW)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SUBOTIN
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102-30 66TH RD
Mailing Address - Street 2:3C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7616
Mailing Address - Country:US
Mailing Address - Phone:917-771-8623
Mailing Address - Fax:718-897-0095
Practice Address - Street 1:102-30 66 ROAD
Practice Address - Street 2:3C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7616
Practice Address - Country:US
Practice Address - Phone:917-771-8623
Practice Address - Fax:718-897-0095
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health