Healthcare Provider Details

I. General information

NPI: 1164346383
Provider Name (Legal Business Name): MIKALA RUTH CARDO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 NEW YORK AVE APT 3C
BROOKLYN NY
11216-4341
US

IV. Provider business mailing address

247 NEW YORK AVE APT 3C
BROOKLYN NY
11216-4341
US

V. Phone/Fax

Practice location:
  • Phone: 619-748-2997
  • Fax:
Mailing address:
  • Phone: 619-748-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number005059-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: