Provider Demographics
NPI:1881225787
Name:TAVAREZ, HELIANA A (LCSW)
Entity Type:Individual
Prefix:
First Name:HELIANA
Middle Name:A
Last Name:TAVAREZ
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 1:43 BRONX RIVER RD APT 6N
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4421
Mailing Address - Country:US
Mailing Address - Phone:646-488-5163
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE FL 7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-8984
Practice Address - Fax:718-652-0131
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker