Provider Demographics
NPI:1871843318
Name:TAVZEL, KERRIANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRIANN
Middle Name:
Last Name:TAVZEL
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 1:21 HAWTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3004
Mailing Address - Country:US
Mailing Address - Phone:914-686-0301
Mailing Address - Fax:
Practice Address - Street 1:9 W PROSPECT AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2018
Practice Address - Country:US
Practice Address - Phone:914-669-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083614-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical