Provider Demographics
NPI:1124410469
Name:BAVARO, NICOLE LAUREN (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAUREN
Last Name:BAVARO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 112TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2349
Mailing Address - Country:US
Mailing Address - Phone:718-263-0740
Mailing Address - Fax:
Practice Address - Street 1:6735 112TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2349
Practice Address - Country:US
Practice Address - Phone:718-263-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087828104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker