Provider Demographics
NPI:1326103698
Name:DAHBANY, AVIVAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVIVAH
Middle Name:
Last Name:DAHBANY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STATE ROUTE 18
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1913
Mailing Address - Country:US
Mailing Address - Phone:732-940-6816
Mailing Address - Fax:732-940-6816
Practice Address - Street 1:223 STATE ROUTE 18
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-940-6816
Practice Address - Fax:732-940-6816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03730103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSI03730OtherLICENSED PSYCHOLOGIST