Provider Demographics
NPI:1427720119
Name:MAVRUK, EBRU
Entity type:Individual
Prefix:
First Name:EBRU
Middle Name:
Last Name:MAVRUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N BROADWAY APT 2B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-7064
Mailing Address - Country:US
Mailing Address - Phone:718-866-4569
Mailing Address - Fax:
Practice Address - Street 1:3000 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8374
Practice Address - Country:US
Practice Address - Phone:347-283-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst