Basic Information
| Provider Information | |||||||||
| NPI: | 1316210008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASHKOWITZ | ||||||||
| FirstName: | AVIVA | ||||||||
| MiddleName: | TOVA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOHL | ||||||||
| OtherFirstName: | AVIVA | ||||||||
| OtherMiddleName: | TOVA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21 LAUREL AVE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | CORNWALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125181469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454584557 | ||||||||
| FaxNumber: | 8454584559 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 LAUREL AVE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | CORNWALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125181469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454584557 | ||||||||
| FaxNumber: | 8454584559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2012 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 078774 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.