Provider Demographics
NPI:1437964707
Name:TAVERAS, AILIN D I (CASAC-T)
Entity type:Individual
Prefix:
First Name:AILIN
Middle Name:D
Last Name:TAVERAS
Suffix:I
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 GRAND CONCOURSE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3799
Mailing Address - Country:US
Mailing Address - Phone:718-690-6071
Mailing Address - Fax:
Practice Address - Street 1:2369 2ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3108
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-06-17
Deactivation Date:2025-05-06
Deactivation Code:
Reactivation Date:2025-06-17
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-T-39924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)