Provider Demographics
NPI:1619641131
Name:GARCIA-DAVRANOVA, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:GARCIA-DAVRANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 BROADWAY
Mailing Address - Street 2:SUITE NUMBER 1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:917-873-1022
Mailing Address - Fax:
Practice Address - Street 1:291 BROADWAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007
Practice Address - Country:US
Practice Address - Phone:917-873-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical