Provider Demographics
NPI:1669019766
Name:AYDIN, KUBRA
Entity Type:Individual
Prefix:
First Name:KUBRA
Middle Name:
Last Name:AYDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KUBRA
Other - Middle Name:
Other - Last Name:AYDIN TANRIVERDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3516
Mailing Address - Country:US
Mailing Address - Phone:508-532-7323
Mailing Address - Fax:508-853-8593
Practice Address - Street 1:19 TACOMA ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3516
Practice Address - Country:US
Practice Address - Phone:508-532-7323
Practice Address - Fax:508-853-8593
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013771101YM0800X
IL178013771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health