Provider Demographics
NPI:1316349152
Name:MINKOVA, SOFIYA (SI, BCBA LBA)
Entity type:Individual
Prefix:
First Name:SOFIYA
Middle Name:
Last Name:MINKOVA
Suffix:
Gender:F
Credentials:SI, BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6613
Mailing Address - Country:US
Mailing Address - Phone:347-553-7881
Mailing Address - Fax:
Practice Address - Street 1:2535 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6613
Practice Address - Country:US
Practice Address - Phone:347-553-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1180428171222Q00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist