Healthcare Provider Details

I. General information

NPI: 1407066251
Provider Name (Legal Business Name): IOANIS PAPAVASSILIU M.A., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLATBUSH AVE
BROOKLYN NY
11217-2812
US

IV. Provider business mailing address

374 12TH ST APT 2
BROOKLYN NY
11215-5002
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-2000
  • Fax:
Mailing address:
  • Phone: 718-832-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: