MEDICARE: DR. AVIVA ANTHEA GITLIN PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	014281-1	NY

General Provider Information

NPI Number	:	1013069145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVIVA ANTHEA GITLIN PSY.D

Provider Business Mailing Address
First Line	:	18 MYRTLE ST
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-2810
Country	:	US
Telephone Number	:	914-997-0732
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 S BROADWAY
Second Line	:	SUITE 512
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-4400
Country	:	US
Telephone Number	:	914-997-0732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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