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General NPI Number Information
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NPI Number | 1083954077
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Entity Type | Organization
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Legal Business Name | AVANTGARDE BEHAVIORAL HEALTH SERVICES LCSW PLLC
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 19 W 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 917-291-2191
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Fax | 718-332-2273
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Provider Business Mailing Address
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Address Line | 145 HASTINGS ST
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City | BROOKLYN
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State | NY
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Zip | 11235-3017
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Country | US
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Telephone | 917-291-2191
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Fax | 718-332-2273
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Authorized Official
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Title or Position | VICE PRESIDENT/OWNER
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Name | LUDMILLA RUBINOV
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Credential | LCSW
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Telephone | 917-291-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 077151
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License Number State | NY
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