Provider Demographics
NPI:1871089557
Name:STEIN, AVRAM ILAN
Entity type:Individual
Prefix:MR
First Name:AVRAM
Middle Name:ILAN
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:AVI
Other - Middle Name:ILAN
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7783 PEMBROOKE PASS
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8844
Mailing Address - Country:US
Mailing Address - Phone:614-270-1072
Mailing Address - Fax:
Practice Address - Street 1:1501 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2121
Practice Address - Country:US
Practice Address - Phone:513-619-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health