Provider Demographics
NPI:1780340810
Name:NEREY AMENEIRO, MIRIELA
Entity type:Individual
Prefix:
First Name:MIRIELA
Middle Name:
Last Name:NEREY AMENEIRO
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 1:66 HAZELTON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1142
Mailing Address - Country:US
Mailing Address - Phone:786-454-6443
Mailing Address - Fax:
Practice Address - Street 1:2 UNIVERSITY PLAZA DRIVE STE 100
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6210
Practice Address - Country:US
Practice Address - Phone:786-454-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-54382103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1-21-54382OtherBACB