Healthcare Provider Details

I. General information

NPI: 1407500846
Provider Name (Legal Business Name): GAVRIELLA KOVACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 162ND ST
WHITESTONE NY
11357-2124
US

IV. Provider business mailing address

1727 MENAHAN ST APT 2R
RIDGEWOOD NY
11385-2104
US

V. Phone/Fax

Practice location:
  • Phone: 718-746-6647
  • Fax:
Mailing address:
  • Phone: 516-317-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: