Healthcare Provider Details

I. General information

NPI: 1407021041
Provider Name (Legal Business Name): DEAVER ALVIN VARNER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WESTCHESTER SQ
BRONX NY
10461-3525
US

IV. Provider business mailing address

1515 GRAND CONCOURSE APARTMENT 6C
BRONX NY
10452-6340
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-4045
  • Fax: 718-828-1318
Mailing address:
  • Phone: 718-931-4045
  • Fax: 718-828-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: