Provider Demographics
NPI:1598003998
Name:MAVIGLIA, ADRIENNE M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:M
Last Name:MAVIGLIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:ADRIENNE
Other - Middle Name:M
Other - Last Name:MAVIGLIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:7 COLT CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1201
Mailing Address - Country:US
Mailing Address - Phone:845-294-1882
Mailing Address - Fax:888-257-0103
Practice Address - Street 1:60 ERIE ST STE 304
Practice Address - Street 2:#6
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1531
Practice Address - Country:US
Practice Address - Phone:845-294-1882
Practice Address - Fax:888-257-0103
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-6391103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst