Basic Information
| Provider Information | |||||||||
| NPI: | 1891435285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MAKAYLA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 BAY AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH MIDDLETOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077485711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003552583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 REGENT ST STE 708 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070391628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5512374646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2022 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.