Provider Demographics
NPI:1225769474
Name:GARCIA-PADIN, MIRELLIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MIRELLIE
Middle Name:
Last Name:GARCIA-PADIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2413
Mailing Address - Country:US
Mailing Address - Phone:305-316-5479
Mailing Address - Fax:
Practice Address - Street 1:4276 COLE AVE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2413
Practice Address - Country:US
Practice Address - Phone:305-316-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty