Provider Demographics
NPI:1073874889
Name:PRIVEN, MILENA (MA, MSED, BCBA, NYS)
Entity type:Individual
Prefix:MRS
First Name:MILENA
Middle Name:
Last Name:PRIVEN
Suffix:
Gender:F
Credentials:MA, MSED, BCBA, NYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GREENCROFT LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3262
Mailing Address - Country:US
Mailing Address - Phone:917-494-9210
Mailing Address - Fax:
Practice Address - Street 1:26 GREENCROFT LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3262
Practice Address - Country:US
Practice Address - Phone:917-494-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1248458174400000X
NY001935103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-42463OtherBCBA
NY54533Medicaid