Provider Demographics
NPI:1003828518
Name:AVIV, SMADAR (PHD)
Entity Type:Individual
Prefix:
First Name:SMADAR
Middle Name:
Last Name:AVIV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 N 11TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3375
Mailing Address - Country:US
Mailing Address - Phone:559-435-0800
Mailing Address - Fax:559-435-7720
Practice Address - Street 1:7131 N 11TH ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3375
Practice Address - Country:US
Practice Address - Phone:559-435-0800
Practice Address - Fax:559-435-7720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9438103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral