Provider Demographics
NPI:1780975334
Name:LESNIAK, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LESNIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3852
Mailing Address - Country:US
Mailing Address - Phone:518-356-6201
Mailing Address - Fax:518-393-2027
Practice Address - Street 1:427 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3852
Practice Address - Country:US
Practice Address - Phone:518-356-6201
Practice Address - Fax:518-393-2027
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 082690104100000X
NY0864101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051104000053OtherFIDELIS
NY02664359Medicaid