Healthcare Provider Details

I. General information

NPI: 1538478201
Provider Name (Legal Business Name): ANDREW LIVANIS PH.D., BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2026
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 TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: