Provider Demographics
NPI:1134799299
Name:CUSTODIO-MIOLAN, ADRIANNY (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ADRIANNY
Middle Name:
Last Name:CUSTODIO-MIOLAN
Suffix:
Gender:
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 1:1 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1510
Mailing Address - Country:US
Mailing Address - Phone:401-548-0238
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-1510
Practice Address - Country:US
Practice Address - Phone:401-548-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILBA00260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst