Provider Demographics
NPI:1053544908
Name:PENA, TATYANA VOLOKITIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:VOLOKITIN
Last Name:PENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:VOLOKITIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 CAUMSETT WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1245
Mailing Address - Country:US
Mailing Address - Phone:347-581-6041
Mailing Address - Fax:
Practice Address - Street 1:43 CAUMSETT WOODS LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1245
Practice Address - Country:US
Practice Address - Phone:347-581-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0809931041C0700X
NY080993-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty