Provider Demographics
NPI:1427820075
Name:LEBOVIC, AVROHOM (LMSW)
Entity type:Individual
Prefix:
First Name:AVROHOM
Middle Name:
Last Name:LEBOVIC
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:ABRAHAM
Other - Middle Name:
Other - Last Name:LEBOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2090 FREDERICK DOUGLASS BLVD APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2790
Mailing Address - Country:US
Mailing Address - Phone:917-365-1416
Mailing Address - Fax:
Practice Address - Street 1:2090 FREDERICK DOUGLASS BLVD APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2790
Practice Address - Country:US
Practice Address - Phone:917-365-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140761104100000X
NJ44SL06963200104100000X
NY120167-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker