Provider Demographics
NPI:1114699311
Name:AVELAR, ABBERDEEN ARIAM (MA,BCBA,LBA,SLPA)
Entity Type:Individual
Prefix:
First Name:ABBERDEEN
Middle Name:ARIAM
Last Name:AVELAR
Suffix:
Gender:F
Credentials:MA,BCBA,LBA,SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18383 W PORT ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-7677
Mailing Address - Country:US
Mailing Address - Phone:818-802-9291
Mailing Address - Fax:
Practice Address - Street 1:21505 N 78TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3356
Practice Address - Country:US
Practice Address - Phone:480-676-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ116942355S0801X
AZBEH-000844103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant