=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093053472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZIVA AVRAMOVICH LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2013
-----------------------------------------------------
Last Update Date | 01/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7390 NW 5TH ST SUITE 5
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-583-8831
-----------------------------------------------------
Fax | 954-583-9575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13306 SW 41ST ST
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33330-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-375-0340
-----------------------------------------------------
Fax | 954-530-9239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. ZIVA AVRAMOVICH
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 786-375-0340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW9294
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------