Provider Demographics
NPI:1952928152
Name:BOHAN, GAVRIELLA
Entity Type:Individual
Prefix:
First Name:GAVRIELLA
Middle Name:
Last Name:BOHAN
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 1:821 WOODMERE CT APT 2D
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2506
Mailing Address - Country:US
Mailing Address - Phone:516-362-9561
Mailing Address - Fax:
Practice Address - Street 1:333 PEARSALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1842
Practice Address - Country:US
Practice Address - Phone:516-213-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBACB481570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst