Provider Demographics
NPI:1194392662
Name:ANVARIPOUR, AVIN (LCSW)
Entity Type:Individual
Prefix:
First Name:AVIN
Middle Name:
Last Name:ANVARIPOUR
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 1:530 BENTEE WES COURT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715
Mailing Address - Country:US
Mailing Address - Phone:812-401-1836
Mailing Address - Fax:124-018-0138
Practice Address - Street 1:60 S STOCKWELL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0247
Practice Address - Country:US
Practice Address - Phone:812-476-5437
Practice Address - Fax:812-436-4316
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99104665A104100000X
IN33010333A104100000X
IN34010754A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker