Provider Demographics
NPI:1265838031
Name:MILLER, MEGAN M (MSED, BCBA, NYS LBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSED, BCBA, NYS LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 78TH ST # 2F
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2847
Mailing Address - Country:US
Mailing Address - Phone:347-697-0904
Mailing Address - Fax:
Practice Address - Street 1:6753 78TH ST # 2F
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2847
Practice Address - Country:US
Practice Address - Phone:347-697-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000473-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst