Provider Demographics
NPI:1053981936
Name:BUXBAUM, YAKOV (LCSW)
Entity type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:BUXBAUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:YAKOV
Other - Middle Name:
Other - Last Name:BUXBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:19 TAFT LN # 201
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1924
Mailing Address - Country:US
Mailing Address - Phone:845-270-4578
Mailing Address - Fax:845-675-4987
Practice Address - Street 1:12 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1908
Practice Address - Country:US
Practice Address - Phone:845-270-4578
Practice Address - Fax:845-675-4987
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0916441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical