Provider Demographics
NPI:1407021041
Name:VARNER, DEAVER ALVIN SR
Entity Type:Individual
Prefix:
First Name:DEAVER
Middle Name:ALVIN
Last Name:VARNER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 GRAND CONCOURSE
Mailing Address - Street 2:APARTMENT 6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-6340
Mailing Address - Country:US
Mailing Address - Phone:718-931-4045
Mailing Address - Fax:718-828-1318
Practice Address - Street 1:55 WESTCHESTER SQ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3525
Practice Address - Country:US
Practice Address - Phone:718-931-4045
Practice Address - Fax:718-828-1318
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health