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General NPI Number Information
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NPI Number | 1326984766
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Entity Type | Individual
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Provider Name | KRISTINA MIRA BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 49 FARMSTEAD LN
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City | GLASTONBURY
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State | CT
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Zip | 06033-3241
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Country | US
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Telephone | 860-899-6970
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Fax |
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Provider Business Mailing Address
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Address Line | 49 FARMSTEAD LN
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City | GLASTONBURY
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State | CT
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Zip | 06033-3241
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Country | US
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Telephone | 860-899-6970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-86720
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License Number State |
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