Provider Demographics
NPI:1386958494
Name:HUERTAS, DENA MICHELE (MS ED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:MICHELE
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 UNION TPKE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1958
Mailing Address - Country:US
Mailing Address - Phone:516-593-0080
Mailing Address - Fax:
Practice Address - Street 1:16216 UNION TPKE
Practice Address - Street 2:SUITE 303
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1958
Practice Address - Country:US
Practice Address - Phone:516-593-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst