Provider Demographics
NPI:1669873451
Name:CATHLEEN RYBAK LCSW PC
Entity type:Organization
Organization Name:CATHLEEN RYBAK LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYBAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-514-1908
Mailing Address - Street 1:80 EAST 11TH STREET SUITE 534
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:917-514-1908
Mailing Address - Fax:
Practice Address - Street 1:799 BROADWAY STE 534
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6815
Practice Address - Country:US
Practice Address - Phone:917-514-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO48818-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty