Provider Demographics
NPI:1609116821
Name:MILLER, KARLEE DYAN (BCBA)
Entity type:Individual
Prefix:MS
First Name:KARLEE
Middle Name:DYAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 30TH AVE
Mailing Address - Street 2:APT 5D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7953
Mailing Address - Country:US
Mailing Address - Phone:832-867-5284
Mailing Address - Fax:
Practice Address - Street 1:5128 30TH AVE
Practice Address - Street 2:APT 5D
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7953
Practice Address - Country:US
Practice Address - Phone:832-867-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst