Healthcare Provider Details

I. General information

NPI: 1811347081
Provider Name (Legal Business Name): LIVANIS BEHAVIORAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 33RD ST
ASTORIA NY
11106-2127
US

IV. Provider business mailing address

3227 33RD ST
ASTORIA NY
11106-2127
US

V. Phone/Fax

Practice location:
  • Phone: 718-564-0237
  • Fax:
Mailing address:
  • Phone: 718-564-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number020
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number020334
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number000501
License Number StateNY

VIII. Authorized Official

Name: ANDREW LIVANIS
Title or Position: PSYCHOLOGIST AND BEHAVIOR ANALYST
Credential: PH.D., BCBA-D, LBA
Phone: 718-564-0237