Provider Demographics
NPI:1013069145
Name:GITLIN, AVIVA ANTHEA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:ANTHEA
Last Name:GITLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2810
Mailing Address - Country:US
Mailing Address - Phone:914-997-0732
Mailing Address - Fax:
Practice Address - Street 1:34 S BROADWAY
Practice Address - Street 2:SUITE 512
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4400
Practice Address - Country:US
Practice Address - Phone:914-997-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014281-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVJ0841Medicare ID - Type Unspecified