Provider Demographics
NPI:1508208695
Name:CHARLAP, AVIVA (CCC)
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:
Last Name:CHARLAP
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:MRS
Other - First Name:AVIVA
Other - Middle Name:
Other - Last Name:CHARLAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC
Mailing Address - Street 1:1 CLUB DR APT 3HL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2009
Mailing Address - Country:US
Mailing Address - Phone:973-896-1725
Mailing Address - Fax:
Practice Address - Street 1:1 CLUB DR APT 3HL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2009
Practice Address - Country:US
Practice Address - Phone:973-896-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist