Healthcare Provider Details

I. General information

NPI: 1316210008
Provider Name (Legal Business Name): AVIVA TOVA BASHKOWITZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVIVA TOVA KOHL LCSW

II. Dates (important events)

Enumeration Date: 02/11/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LAUREL AVE SUITE 290
CORNWALL NY
12518-1469
US

IV. Provider business mailing address

21 LAUREL AVE SUITE 290
CORNWALL NY
12518-1469
US

V. Phone/Fax

Practice location:
  • Phone: 845-458-4557
  • Fax: 845-458-4559
Mailing address:
  • Phone: 845-458-4557
  • Fax: 845-458-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: