Provider Demographics
NPI:1508915158
Name:SALA, AVIVA E (LCSW)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:E
Last Name:SALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1220
Mailing Address - Country:US
Mailing Address - Phone:516-293-4060
Mailing Address - Fax:
Practice Address - Street 1:44 SIMPSON DR
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1220
Practice Address - Country:US
Practice Address - Phone:516-293-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0514151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY460598OtherVALUE OPTIONS PROVIDER ID