Provider Demographics
NPI:1568833069
Name:UDAZE, JOHN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:UDAZE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3218
Mailing Address - Country:US
Mailing Address - Phone:631-833-9296
Mailing Address - Fax:
Practice Address - Street 1:12 HENRY AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3218
Practice Address - Country:US
Practice Address - Phone:631-833-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst