Provider Demographics
NPI:1891159307
Name:AVRAMOV, FAREKHO (MA)
Entity Type:Individual
Prefix:MRS
First Name:FAREKHO
Middle Name:
Last Name:AVRAMOV
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14449 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1717
Mailing Address - Country:US
Mailing Address - Phone:917-600-9838
Mailing Address - Fax:
Practice Address - Street 1:14449 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1717
Practice Address - Country:US
Practice Address - Phone:917-600-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1002346151103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst