Provider Demographics
NPI:1902504798
Name:KAVALIN, AD (LMSW)
Entity Type:Individual
Prefix:
First Name:AD
Middle Name:
Last Name:KAVALIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 7TH AVE STE 1106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-0029
Mailing Address - Country:US
Mailing Address - Phone:908-577-7685
Mailing Address - Fax:
Practice Address - Street 1:1618 JEFFERSON AVE APT 2E
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4709
Practice Address - Country:US
Practice Address - Phone:908-577-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1201521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical