Provider Demographics
NPI:1871038596
Name:AVIV THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:AVIV THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DAVIDA
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-426-6829
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:BOTSFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06404-0123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 MONROE TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2343
Practice Address - Country:US
Practice Address - Phone:203-733-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003327251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health