1316210008 NPI number — MRS. AVIVA TOVA BASHKOWITZ LCSW

Table of content: MRS. AVIVA TOVA BASHKOWITZ LCSW (NPI 1316210008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316210008 NPI number — MRS. AVIVA TOVA BASHKOWITZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASHKOWITZ
Provider First Name:
AVIVA
Provider Middle Name:
TOVA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOHL
Provider Other First Name:
AVIVA
Provider Other Middle Name:
TOVA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316210008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 LAUREL AVE
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
CORNWALL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12518-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-458-4557
Provider Business Mailing Address Fax Number:
845-458-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 LAUREL AVE
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
CORNWALL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12518-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-458-4557
Provider Business Practice Location Address Fax Number:
845-458-4559
Provider Enumeration Date:
02/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  078774 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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