Healthcare Provider Details

I. General information

NPI: 1679710958
Provider Name (Legal Business Name): EFRAT AHARONOVICH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PARK AVE SUITE 1B
NEW YORK NY
10128-1202
US

IV. Provider business mailing address

1100 PARK AVE SUITE 1B
NEW YORK NY
10128-1202
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-8139
  • Fax:
Mailing address:
  • Phone: 212-289-8139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number013628-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number013628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: