Provider Demographics
NPI:1912700055
Name:ELCHONEN, MIRIAM (BCBA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ELCHONEN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25911 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1027
Mailing Address - Country:US
Mailing Address - Phone:947-948-6513
Mailing Address - Fax:
Practice Address - Street 1:1776 AVE OF THE STATES STE 101A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4592
Practice Address - Country:US
Practice Address - Phone:732-838-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst