Provider Demographics
NPI:1043896244
Name:AVENA PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:AVENA PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:AVENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:302-463-7889
Mailing Address - Street 1:226 E 85TH ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3099
Mailing Address - Country:US
Mailing Address - Phone:302-463-7889
Mailing Address - Fax:
Practice Address - Street 1:226 E 85TH ST APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3099
Practice Address - Country:US
Practice Address - Phone:302-463-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty