Organization
AVITA INTEGRATIVE CARE, LLC
Active
Other names
Avita iCare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KALMAN KHODIK PSY.D (OWNER/CLINICAL DIRECTOR)
(888) 242-2732
Entity
Organization
Contact information
Practice address
440 WEST ST STE 312, FORT LEE, NJ 07024-5028
(888) 242-2732
(888) 242-2732
Mailing address
440 WEST ST STE 312, FORT LEE, NJ 07024-5028
(888) 242-2732
(888) 242-2732
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
021116
NY
103T00000X
Psychologist
0450041113
NJ
103TC0700X
Clinical Psychologist
Primary
0450041113
NJ
Other
Enumeration date
11/17/2016
Last updated
06/13/2022
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