Provider Demographics
NPI:1386417202
Name:CABAN, AJA
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:CABAN
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 1:17 HERKIMER RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2309
Mailing Address - Country:US
Mailing Address - Phone:315-832-4698
Mailing Address - Fax:
Practice Address - Street 1:17 HERKIMER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2309
Practice Address - Country:US
Practice Address - Phone:315-832-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP124911104100000X
NY123416-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker