Provider Demographics
NPI:1740481761
Name:BAVARSKY, ANITA (PSYD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BAVARSKY
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 1:6671 BIRCHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3204
Mailing Address - Country:US
Mailing Address - Phone:818-340-4999
Mailing Address - Fax:818-340-1745
Practice Address - Street 1:23123 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1175
Practice Address - Country:US
Practice Address - Phone:818-340-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40516106H00000X
CAPSY 22481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist