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General NPI Number Information
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NPI Number | 1932801495
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Entity Type | Organization
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Legal Business Name | LIVANIS PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 2571 47TH ST
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City | ASTORIA
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State | NY
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Zip | 11103-1108
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Country | US
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Telephone | 718-564-0237
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Fax | 407-880-4344
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Provider Business Mailing Address
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Address Line | 2571 47TH ST
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City | ASTORIA
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State | NY
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Zip | 11103-1108
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Country | US
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Telephone | 718-564-0237
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Fax | 407-880-4344
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Authorized Official
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Title or Position | P
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Name | ANDREW LIVANIS
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Credential | PHD, BCBA-D
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Telephone | 718-564-0237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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