| Doctor Name: | DR. KAVITA BASAVARAJU |
| NPI Number: | 1457505547 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 009982 |
| Business Practice Address: | 90 Glen Cove Rd Greenvale, NY - 115481038 |
| Business Phone Number: | 5163765150 |
| Business Fax Number: | |
| Mailing Address: | 378 Elm Dr, ROSLYN |
| State: | NY |
| Postal Code: | 115763013 |
| Phone Number: | 5163765150 |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2008 |
| NPI Last Update Date: | 11/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 009982 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |