MEDICARE: MRS. AVIVA LAYA BERKOVITS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1467911164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVIVA LAYA BERKOVITS

Provider Business Mailing Address
First Line	:	1324 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5311
Country	:	US
Telephone Number	:	917-865-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5311
Country	:	US
Telephone Number	:	917-865-1941
Fax Number	:

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

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	02/13/2024

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