Provider Demographics
NPI:1477373561
Name:ABIR, AVITAL (CT)
Entity type:Individual
Prefix:
First Name:AVITAL
Middle Name:
Last Name:ABIR
Suffix:
Gender:F
Credentials:CT
Other - Prefix:MRS
Other - First Name:AVITAL
Other - Middle Name:
Other - Last Name:MINTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CT
Mailing Address - Street 1:24326 MAIDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1606
Mailing Address - Country:US
Mailing Address - Phone:561-306-7632
Mailing Address - Fax:
Practice Address - Street 1:25101 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5643
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405794-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health