Provider Demographics
NPI:1447910435
Name:MAVASHEV, HADAS (LSW)
Entity type:Individual
Prefix:MRS
First Name:HADAS
Middle Name:
Last Name:MAVASHEV
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2228
Mailing Address - Country:US
Mailing Address - Phone:973-687-4804
Mailing Address - Fax:
Practice Address - Street 1:240 W PASSAIC ST STE 10
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1264
Practice Address - Country:US
Practice Address - Phone:908-228-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06703200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty