Provider Demographics
NPI:1962226787
Name:WISNIEWSKI, MIAH LEA
Entity type:Individual
Prefix:
First Name:MIAH
Middle Name:LEA
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3021
Mailing Address - Country:US
Mailing Address - Phone:845-863-5208
Mailing Address - Fax:
Practice Address - Street 1:118 RIVER RD
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3021
Practice Address - Country:US
Practice Address - Phone:845-863-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician