Individual
AVIVA GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5-31 50TH AVENUE, LONG ISLAND CITY, NY 11101
(917) 647-9042
Mailing address
5-31 50TH AVENUE, LONG ISLAND CITY, NY 11101
(917) 647-9042
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
016583
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016583
—
NY
Enumeration date
05/12/2006
Last updated
04/12/2016
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