Provider Demographics
NPI:1851517270
Name:AWARENESS PSYCHOLOGICAL HEALTH AND GROWTH SERVICES
Entity Type:Organization
Organization Name:AWARENESS PSYCHOLOGICAL HEALTH AND GROWTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIVCKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-429-8049
Mailing Address - Street 1:125 PLEASANT ST APT 609
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-7183
Mailing Address - Country:US
Mailing Address - Phone:617-277-1961
Mailing Address - Fax:
Practice Address - Street 1:1394 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2205
Practice Address - Country:US
Practice Address - Phone:617-429-8049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8090-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5332OtherEMPIRE BLUE CROSS
NY058472OtherVALUE OPTIONS
NY81182000OtherMAGELLAN BEHAVIORAL HEALT
NYV5332Medicare ID - Type UnspecifiedEMPIRE BLUE CROSS