Provider Demographics
NPI:1861790719
Name:SUKENICK, EDWARD MARK
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARK
Last Name:SUKENICK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:MARK
Other - Last Name:SUKENICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED SOCIAL WOR
Mailing Address - Street 1:114 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0919
Mailing Address - Country:US
Mailing Address - Phone:212-879-3451
Mailing Address - Fax:
Practice Address - Street 1:114 E 84TH ST
Practice Address - Street 2:167 E 82ST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0919
Practice Address - Country:US
Practice Address - Phone:212-879-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0123211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical