Provider Demographics
NPI:1871582510
Name:ZAK, VIVIEN K (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:VIVIEN K
Middle Name:
Last Name:ZAK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EIGHTH AVE
Mailing Address - Street 2:STE. 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3739
Mailing Address - Country:US
Mailing Address - Phone:917-804-0477
Mailing Address - Fax:
Practice Address - Street 1:36 PLAZA ST E STE 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5039
Practice Address - Country:US
Practice Address - Phone:917-804-0477
Practice Address - Fax:718-766-9741
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045147-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-045147-1Other1041C0700X - SOCIAL WORKER - CLINICAL
NY11512946OtherCAQH PROVIDER ID
NYR-045147-1Other1041C0700X - SOCIAL WORKER - CLINICAL