=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578382628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIND HEARTS APPLIED BEHAVIOR ANALYSIS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 GREENCROFT LANE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-494-9210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 GREENCROFT LANE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-494-9210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER
-----------------------------------------------------
Name | MRS. MILENA PRIVEN
-----------------------------------------------------
Credential | MA, MSED, BCBA, LBA
-----------------------------------------------------
Telephone | 917-494-9210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------