Healthcare Provider Details

I. General information

NPI: 1326828211
Provider Name (Legal Business Name): AVA SLOBODA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEGRAW AVE
TEANECK NJ
07666-4094
US

IV. Provider business mailing address

12 WINSTON PL
MARLBORO NY
12542-5967
US

V. Phone/Fax

Practice location:
  • Phone: 551-363-3303
  • Fax:
Mailing address:
  • Phone: 845-863-5208
  • Fax: 845-395-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00413900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: