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General NPI Number Information
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NPI Number | 1821950619
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Entity Type | Individual
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Provider Name | OLIVIA AVESON PHD
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 462 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-9196
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Country | US
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Telephone | 212-562-8976
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Fax |
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Provider Business Mailing Address
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Address Line | 220 E 36TH ST APT D1
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City | NEW YORK
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State | NY
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Zip | 10016-3753
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 027632
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License Number State | NY
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