Provider Demographics
NPI:1588488282
Name:GAVORA, ANDREA (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GAVORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 38TH ST APT 7A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4132
Mailing Address - Country:US
Mailing Address - Phone:917-647-7275
Mailing Address - Fax:
Practice Address - Street 1:2924 HOYT AVE S
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1738
Practice Address - Country:US
Practice Address - Phone:718-721-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098501-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical