Healthcare Provider Details

I. General information

NPI: 1992909253
Provider Name (Legal Business Name): ZIVIA BAIREY CREATIVE A T SOC WKR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RISLEY PLACE
NEW ROCHELLE NY
10801
US

IV. Provider business mailing address

27020 CEDAR RD APT 117-1
BEACHWOOD OH
44122-1136
US

V. Phone/Fax

Practice location:
  • Phone: 914-632-0242
  • Fax:
Mailing address:
  • Phone: 917-518-8595
  • Fax: 216-765-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 0700015
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW075860
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberLCAT000015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: