Healthcare Provider Details

I. General information

NPI: 1194618280
Provider Name (Legal Business Name): ANDRE GAVRIN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S OYSTER BAY RD
PLAINVIEW NY
11803-3310
US

IV. Provider business mailing address

11 SEABURY RD
GARDEN CITY NY
11530-1914
US

V. Phone/Fax

Practice location:
  • Phone: 516-417-4760
  • Fax:
Mailing address:
  • Phone: 516-417-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: