Provider Demographics
NPI:1972865822
Name:BAVOLAR, VIRGINIA ANNE (MASPECIAL EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:BAVOLAR
Suffix:
Gender:F
Credentials:MASPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5612
Mailing Address - Country:US
Mailing Address - Phone:631-499-1237
Mailing Address - Fax:631-499-1074
Practice Address - Street 1:29 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-499-1237
Practice Address - Fax:631-499-1074
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist