Provider Demographics
NPI:1417206376
Name:MCPHERSON, AVIVAH (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:AVIVAH
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AVIVAH
Other - Middle Name:
Other - Last Name:MCDADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:57 FORSYTH STREET NORTHWEST
Mailing Address - Street 2:#4C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:718-674-4452
Mailing Address - Fax:415-206-4722
Practice Address - Street 1:57 FORSYTH STREET NORTHWEST
Practice Address - Street 2:#4C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:718-674-4452
Practice Address - Fax:415-206-4722
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32009103TC2200X
GAPS-T001100103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent