Provider Demographics
NPI:1679024483
Name:ALBANESE, AVA VICTORIA
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:VICTORIA
Last Name:ALBANESE
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 1:801 S RANCHO DR
Mailing Address - Street 2:STE E3B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3854
Mailing Address - Country:US
Mailing Address - Phone:702-771-5578
Mailing Address - Fax:702-906-1436
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:STE E3B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-771-5578
Practice Address - Fax:702-906-1436
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst