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General NPI Number Information
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NPI Number | 1437964707
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Entity Type | Individual
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Provider Name | AILIN D TAVERAS I CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2369 2ND AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10035-3108
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Country | US
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Telephone | 212-876-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2715 GRAND CONCOURSE APT 6B
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City | BRONX
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State | NY
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Zip | 10468-3799
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Country | US
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Telephone | 718-690-6071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CASAC-T-39924
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License Number State | NY
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