Provider Demographics
NPI:1033440839
Name:ATZRAM, AVA WEINSTEIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:WEINSTEIN
Last Name:ATZRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 BORBECK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3512
Mailing Address - Country:US
Mailing Address - Phone:215-745-5286
Mailing Address - Fax:
Practice Address - Street 1:1234 BRIDGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-2208
Practice Address - Country:US
Practice Address - Phone:267-240-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0162371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical