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NPI Code Detail

MEDICARE: AVA SOBERMAN MFT INTERN

MEDICARE: AVA SOBERMAN MFT INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1306690037
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVA SOBERMAN MFT INTERN
Provider Business Mailing Address
First Line : 156 BEACH 9TH ST STE C
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-5600
Country : US
Telephone Number : 718-686-3149
Fax Number : 718-686-4149
Provider Business Practice Location Address
First Line : 156 BEACH 9TH ST STE C
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-5600
Country : US
Telephone Number : 718-686-3149
Fax Number : 718-686-4149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2024
Last Update Date : 04/17/2024

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Directions to “ AVA SOBERMAN MFT INTERN” Practice Location

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