Healthcare Provider Details

I. General information

NPI: 1659990893
Provider Name (Legal Business Name): ANDREA MIZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 FLYNN AVE
MOORESTOWN NJ
08057-1658
US

IV. Provider business mailing address

118 FLYNN AVE
MOORESTOWN NJ
08057-1658
US

V. Phone/Fax

Practice location:
  • Phone: 856-430-4691
  • Fax:
Mailing address:
  • Phone: 856-430-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39331
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: