Provider Demographics
NPI:1285016105
Name:VAVAL, PRINCEANN
Entity Type:Individual
Prefix:
First Name:PRINCEANN
Middle Name:
Last Name:VAVAL
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 1:354 E 21ST ST
Mailing Address - Street 2:APT 1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-8331
Mailing Address - Country:US
Mailing Address - Phone:347-432-1119
Mailing Address - Fax:
Practice Address - Street 1:354 E 21ST ST
Practice Address - Street 2:APT 1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-8331
Practice Address - Country:US
Practice Address - Phone:347-432-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist