MEDICARE: CHRISTINA A MILLER BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-12-11569	NJ

General Provider Information

NPI Number	:	1619226511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA A MILLER BCBA

Provider Business Mailing Address
First Line	:	24 MEADOW LARK RD
Second Line	:
City	:	STRATFORD
State	:	NJ
Zip	:	08084-1910
Country	:	US
Telephone Number	:	888-859-7749
Fax Number	:	888-859-7749

Provider Business Practice Location Address
First Line	:	500 S BURNT MILL RD
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2205
Country	:	US
Telephone Number	:	888-859-7749
Fax Number	:	888-859-7749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	10/11/2019

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