Provider Demographics
NPI:1962900811
Name:SOLEIMANI, AVIGAIL (MS,BCBA)
Entity type:Individual
Prefix:MRS
First Name:AVIGAIL
Middle Name:
Last Name:SOLEIMANI
Suffix:
Gender:F
Credentials:MS,BCBA
Other - Prefix:MRS
Other - First Name:AVIGAIL
Other - Middle Name:
Other - Last Name:STAVRACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,BCBA
Mailing Address - Street 1:420 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4865
Mailing Address - Country:US
Mailing Address - Phone:732-370-7621
Mailing Address - Fax:
Practice Address - Street 1:420 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4865
Practice Address - Country:US
Practice Address - Phone:917-412-0082
Practice Address - Fax:732-370-7621
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-28306103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst