Provider Demographics
NPI:1962026740
Name:GOVINDAVARI, MARY RUTH
Entity Type:Individual
Prefix:
First Name:MARY RUTH
Middle Name:
Last Name:GOVINDAVARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122A SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4034
Mailing Address - Country:US
Mailing Address - Phone:347-534-6991
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E STE 411
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3245
Practice Address - Country:US
Practice Address - Phone:212-678-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty