Healthcare Provider Details

I. General information

NPI: 1962026740
Provider Name (Legal Business Name): MARY RUTH GOVINDAVARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 UNION SQ E STE 411
NEW YORK NY
10003-3245
US

IV. Provider business mailing address

122A SAINT NICHOLAS AVE
BROOKLYN NY
11237-4034
US

V. Phone/Fax

Practice location:
  • Phone: 212-678-0252
  • Fax:
Mailing address:
  • Phone: 347-534-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: