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General NPI Number Information
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NPI Number | 1902616964
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Entity Type | Individual
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Provider Name | MIRIAM BURLAKOVSKY ED.S, BCBA, LEP#4368
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Gender | Female
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 901 OAK PARK BLVD STE 202
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City | PISMO BEACH
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State | CA
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Zip | 93449-3410
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Country | US
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Telephone | 805-316-1410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 565
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City | PISMO BEACH
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State | CA
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Zip | 93448-0565
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Country | US
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Telephone | 805-316-1410
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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 | 1-12-10527
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 4368
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License Number State | CA
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