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Organization

AVANTGARDE BEHAVIORAL HEALTH SERVICES LCSW PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LUDMILLA RUBINOV LCSW (VICE PRESIDENT/OWNER)
(917) 291-2191
Entity
Organization

Contact information

Practice address
19 W 34TH ST, NEW YORK, NY 10001-3006
(917) 291-2191
(718) 332-2273
Mailing address
145 HASTINGS ST, BROOKLYN, NY 11235-3017
(917) 291-2191
(718) 332-2273

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
077151
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00077151
NY
01
1487737169
NPI
01
A400042543
MEDICARE
NY
Enumeration date
02/27/2013
Last updated
02/27/2013
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