Provider Demographics
NPI:1740621994
Name:ARAVENA, KRISTIN MARIE (AU,D)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:ARAVENA
Suffix:
Gender:F
Credentials:AU,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1607
Mailing Address - Country:US
Mailing Address - Phone:917-305-7700
Mailing Address - Fax:917-305-7819
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:917-305-7700
Practice Address - Fax:917-305-7819
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002484-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist