Provider Demographics
NPI:1386096600
Name:BICK, MIRIAM (MST ED BCBA)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:BICK
Suffix:
Gender:F
Credentials:MST ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3465
Mailing Address - Country:US
Mailing Address - Phone:732-987-4007
Mailing Address - Fax:
Practice Address - Street 1:4 FLORIDA PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1816
Practice Address - Country:US
Practice Address - Phone:973-955-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist