Provider Demographics
NPI:1235967670
Name:PYATETSKAYA, TAMARA (LMSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:PYATETSKAYA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 E 19TH ST APT F1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5419
Mailing Address - Country:US
Mailing Address - Phone:917-576-3334
Mailing Address - Fax:
Practice Address - Street 1:1289 E 19TH ST APT F1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5419
Practice Address - Country:US
Practice Address - Phone:917-576-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker