Provider Demographics
NPI:1073274189
Name:DUDOVA, VIERA (NCSP, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:VIERA
Middle Name:
Last Name:DUDOVA
Suffix:
Gender:F
Credentials:NCSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CLOVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1044
Mailing Address - Country:US
Mailing Address - Phone:908-377-6962
Mailing Address - Fax:
Practice Address - Street 1:108 CLOVER HILL RD
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1044
Practice Address - Country:US
Practice Address - Phone:908-377-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-56649103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst