Provider Demographics
NPI:1598962250
Name:HENDRICKSON, AVIS (EDD)
Entity type:Individual
Prefix:DR
First Name:AVIS
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:EDUCATIONAL
Other - Middle Name:CONSULTATION
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:976 MCLEAN AVE
Mailing Address - Street 2:SUITE 297
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:212-946-6520
Mailing Address - Fax:914-668-3044
Practice Address - Street 1:976 MCLEAN AVE
Practice Address - Street 2:SUITE 297
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4105
Practice Address - Country:US
Practice Address - Phone:212-946-6520
Practice Address - Fax:914-668-3044
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YS0200X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor