Individual provider Active NPI

Aviva Y Marlin, PSYD

  • Clinical Neuropsychologist
  • Bethlehem, PA
National Provider Identifier
1962891663
Registry record updated Feb 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PS018374 Issued in PA
Practice address
1417 8TH Ave
Bethlehem, PA 18018-2256
Phone
(484) 526-5210
Fax
(484) 526-5237
NPI assigned
Jan 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PS018374 PA Primary

Addresses

Primary practice location

1417 8TH Ave
Bethlehem, PA 18018-2256

Mailing address

1417 8TH Ave
Bethlehem, PA 18018-2256
Phone (484) 526-5210

Other practice location 1

3724 Olentangy River Rd Ste A
Columbus, OH 43214-3456
Phone (614) 566-5858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PS018374PAMDClinical Neuropsychologist

Interoperability endpoints

  • Direct secure messaging: aviva.marlin@slpg.direct-sluhn.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518998400000",
    "number": "1962891663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 8TH AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180182256",
            "telephone_number": "484-526-5210",
            "fax_number": "484-526-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 8TH AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180182256",
            "telephone_number": "484-526-5210",
            "fax_number": "484-526-5237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3724 Olentangy River Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143456",
            "country_code": "US",
            "telephone_number": "614-566-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARLIN",
        "first_name": "AVIVA",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-18",
        "last_updated": "2018-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS018374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.