Provider Demographics
NPI:1316210008
Name:BASHKOWITZ, AVIVA TOVA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:TOVA
Last Name:BASHKOWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:AVIVA
Other - Middle Name:TOVA
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:21 LAUREL AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1469
Mailing Address - Country:US
Mailing Address - Phone:845-458-4557
Mailing Address - Fax:845-458-4559
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1469
Practice Address - Country:US
Practice Address - Phone:845-458-4557
Practice Address - Fax:845-458-4559
Is Sole Proprietor?:No
Enumeration Date:2012-02-11
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0787741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical