Provider Demographics
NPI:1639481039
Name:AEDER, TALI
Entity type:Individual
Prefix:
First Name:TALI
Middle Name:
Last Name:AEDER
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 1:1310 48TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3153
Mailing Address - Country:US
Mailing Address - Phone:347-559-8254
Mailing Address - Fax:
Practice Address - Street 1:1310 48TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3153
Practice Address - Country:US
Practice Address - Phone:347-559-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical