Provider Demographics
NPI:1699880286
Name:SOBEL, ANA AVIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:AVIA
Last Name:SOBEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2912
Mailing Address - Country:US
Mailing Address - Phone:518-438-6590
Mailing Address - Fax:518-438-9750
Practice Address - Street 1:135 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2912
Practice Address - Country:US
Practice Address - Phone:518-438-6590
Practice Address - Fax:518-438-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016306-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0832Medicare ID - Type Unspecified