Healthcare Provider Details

I. General information

NPI: 1437964707
Provider Name (Legal Business Name): AILIN D TAVERAS I CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date: 05/06/2025
Reactivation Date: 06/17/2025

III. Provider practice location address

2369 2ND AVE FL 2
NEW YORK NY
10035-3108
US

IV. Provider business mailing address

2715 GRAND CONCOURSE APT 6B
BRONX NY
10468-3799
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax:
Mailing address:
  • Phone: 718-690-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCASAC-T-39924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: