Healthcare Provider Details

I. General information

NPI: 1881383784
Provider Name (Legal Business Name): PAVITRI B JAGNANDAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CORPORATE BLVD S STE 200
YONKERS NY
10701-6820
US

IV. Provider business mailing address

200 CORPORATE BLVD S STE 200
YONKERS NY
10701-6820
US

V. Phone/Fax

Practice location:
  • Phone: 347-335-3403
  • Fax:
Mailing address:
  • Phone: 347-335-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090557
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: