Provider Demographics
NPI:1669961991
Name:VIGDORCHIK, SVETLANA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:VIGDORCHIK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 PALISADE AVE APT 11L
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5314
Mailing Address - Country:US
Mailing Address - Phone:201-849-5797
Mailing Address - Fax:201-254-8095
Practice Address - Street 1:1564 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5635
Practice Address - Country:US
Practice Address - Phone:201-849-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-9-5326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty