Provider Demographics
NPI:1841556362
Name:PLOOG, FLAVIA MIRIAM (FLAVIA PLOOG)
Entity Type:Individual
Prefix:MS
First Name:FLAVIA
Middle Name:MIRIAM
Last Name:PLOOG
Suffix:
Gender:F
Credentials:FLAVIA PLOOG
Other - Prefix:MS
Other - First Name:FLAVIA
Other - Middle Name:MIRIAM
Other - Last Name:PLOOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED, BCBA
Mailing Address - Street 1:201 S 18TH ST
Mailing Address - Street 2:1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5957
Mailing Address - Country:US
Mailing Address - Phone:267-648-4808
Mailing Address - Fax:
Practice Address - Street 1:201 S 18TH ST
Practice Address - Street 2:1402
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5957
Practice Address - Country:US
Practice Address - Phone:267-648-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst