Organization
AVANTGARDE BEHAVIORAL HEALTH SERVICES LCSW PLLC
Active
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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