Provider Demographics
NPI:1235674789
Name:KEMMOUN, AVIGAIL
Entity Type:Individual
Prefix:MRS
First Name:AVIGAIL
Middle Name:
Last Name:KEMMOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 DOWN HILL RUN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1021
Mailing Address - Country:US
Mailing Address - Phone:216-970-4257
Mailing Address - Fax:
Practice Address - Street 1:222 DOWN HILL RUN
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1021
Practice Address - Country:US
Practice Address - Phone:216-970-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-24727103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst