Provider Demographics
NPI:1477187805
Name:NEW AVIV, LLC
Entity Type:Organization
Organization Name:NEW AVIV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:561-523-8190
Mailing Address - Street 1:130 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5503
Mailing Address - Country:US
Mailing Address - Phone:561-523-8190
Mailing Address - Fax:
Practice Address - Street 1:506 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1529
Practice Address - Country:US
Practice Address - Phone:857-284-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty