Provider Demographics
NPI:1245605294
Name:ANVARI, BITA (MS)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:ANVARI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PICCADILLY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1545
Mailing Address - Country:US
Mailing Address - Phone:516-633-1010
Mailing Address - Fax:
Practice Address - Street 1:73 PICCADILLY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1545
Practice Address - Country:US
Practice Address - Phone:516-633-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1976747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst