Provider Demographics
NPI:1891330411
Name:MAZA, MALKA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MALKA
Middle Name:
Last Name:MAZA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SCHUNNEMUNK RD UNIT 112
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6257
Mailing Address - Country:US
Mailing Address - Phone:845-477-5000
Mailing Address - Fax:
Practice Address - Street 1:105 SCHUNNEMUNK RD UNIT 112
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6257
Practice Address - Country:US
Practice Address - Phone:845-477-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-18-30553103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst