Provider Demographics
NPI:1326828211
Name:SLOBODA, AVA
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:SLOBODA
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 1:12 WINSTON PL
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5967
Mailing Address - Country:US
Mailing Address - Phone:845-863-5208
Mailing Address - Fax:845-395-9296
Practice Address - Street 1:118 RIVER RD STE 14
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3040
Practice Address - Country:US
Practice Address - Phone:845-863-5208
Practice Address - Fax:845-395-9296
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician