Provider Demographics
NPI:1104512532
Name:MILLIONARD, MALINEDA MANDY (MS, ABA)
Entity type:Individual
Prefix:MS
First Name:MALINEDA
Middle Name:MANDY
Last Name:MILLIONARD
Suffix:
Gender:F
Credentials:MS, ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S MUNN AVE APT 9K
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3683
Mailing Address - Country:US
Mailing Address - Phone:646-651-9719
Mailing Address - Fax:
Practice Address - Street 1:44 S MUNN AVE APT 9K
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3683
Practice Address - Country:US
Practice Address - Phone:646-651-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities