Provider Demographics
NPI:1023513272
Name:MIANO, ASHLEY NICOLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:MIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2305
Mailing Address - Country:US
Mailing Address - Phone:860-424-7540
Mailing Address - Fax:
Practice Address - Street 1:60 CONWAY PARKWAY
Practice Address - Street 2:BUILDING 2B, SUITE 110
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-901-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-18-29601103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst