Provider Demographics
NPI:1851852545
Name:AVITA INTEGRATIVE PSYCHOLOGY CARE PLLC
Entity Type:Organization
Organization Name:AVITA INTEGRATIVE PSYCHOLOGY CARE PLLC
Other - Org Name:AVITA PSYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODIK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-284-8272
Mailing Address - Street 1:1177 AVENUE OF THE AMERICAS FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2714
Mailing Address - Country:US
Mailing Address - Phone:888-284-8272
Mailing Address - Fax:888-284-8272
Practice Address - Street 1:1177 AVENUE OF THE AMERICAS FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2714
Practice Address - Country:US
Practice Address - Phone:888-284-8272
Practice Address - Fax:888-284-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty