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General NPI Number Information
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NPI Number | 1619602448
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Entity Type | Organization
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Legal Business Name | AMAVERA LCSW PLLC
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 07/16/2022
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Provider Practice Location Address
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Address Line | 230 E 79TH ST APT 7A
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City | NEW YORK
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State | NY
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Zip | 10075-1213
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Country | US
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Telephone | 917-279-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 515 MADISON AVE 9TH FLOOR #9062
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 917-279-3789
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JILLIAN TUCKER
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Credential | DSW, LCSW
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Telephone | 917-279-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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