Provider Demographics
NPI:1184737645
Name:NOVAK ZIARNIK, RENATA VIOLETTA (LCSW)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:VIOLETTA
Last Name:NOVAK ZIARNIK
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 1:20 W 20TH ST
Mailing Address - Street 2:FLOOR 2, SUITE 232
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4213
Mailing Address - Country:US
Mailing Address - Phone:646-420-9998
Mailing Address - Fax:
Practice Address - Street 1:20 W 20TH ST
Practice Address - Street 2:FLOOR 2, SUITE 232
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4213
Practice Address - Country:US
Practice Address - Phone:646-420-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0709181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00070918Medicaid
NYN7X311Medicare ID - Type Unspecified