Provider Demographics
NPI:1326385725
Name:AVISSAR, ARIEL M (MA, MT-BC, LCAT)
Entity Type:Individual
Prefix:MR
First Name:ARIEL
Middle Name:M
Last Name:AVISSAR
Suffix:
Gender:M
Credentials:MA, MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 5TH AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2824
Mailing Address - Country:US
Mailing Address - Phone:301-928-9494
Mailing Address - Fax:
Practice Address - Street 1:281 EDGECOMBE AVE APT 7F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3004
Practice Address - Country:US
Practice Address - Phone:301-928-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001513101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
08744OtherMT-BC (CERTIFICATION BOARD FOR MUSIC THERAPISTS)