Provider Demographics
NPI:1215953120
Name:BARDAVID, HERBERT (MSW)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:BARDAVID
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2510
Mailing Address - Country:US
Mailing Address - Phone:516-829-6931
Mailing Address - Fax:516-466-6541
Practice Address - Street 1:5 SHADOW LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2510
Practice Address - Country:US
Practice Address - Phone:516-829-6931
Practice Address - Fax:516-466-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0175801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN00601Medicare ID - Type Unspecified