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General NPI Number Information
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NPI Number | 1912700055
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Entity Type | Individual
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Provider Name | MIRIAM ELCHONEN BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1776 AVE OF THE STATES STE 101A
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4592
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Country | US
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Telephone | 732-838-9039
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Fax |
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Provider Business Mailing Address
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Address Line | 25911 STRATFORD PL
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City | OAK PARK
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State | MI
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Zip | 48237-1027
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Country | US
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Telephone | 947-948-6513
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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 |
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License Number State |
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