Provider Demographics
NPI:1508107780
Name:SAN JOSE, MICHELLE MILANES (MSW, BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MILANES
Last Name:SAN JOSE
Suffix:
Gender:F
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 9TH ST STE 219
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2557
Mailing Address - Country:US
Mailing Address - Phone:707-344-5800
Mailing Address - Fax:
Practice Address - Street 1:2560 9TH ST STE 219
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2557
Practice Address - Country:US
Practice Address - Phone:707-344-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst