Provider Demographics
NPI:1740539808
Name:ALJADEFF-ABERGEL, ELIAN
Entity type:Individual
Prefix:
First Name:ELIAN
Middle Name:
Last Name:ALJADEFF-ABERGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIAN
Other - Middle Name:
Other - Last Name:ALJADEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4415 FOXFIRE TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-9572
Mailing Address - Country:US
Mailing Address - Phone:702-343-6023
Mailing Address - Fax:
Practice Address - Street 1:4415 FOXFIRE TRL
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-9572
Practice Address - Country:US
Practice Address - Phone:702-343-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst