Provider Demographics
NPI:1972080109
Name:TOMASES, MIRIAM (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:TOMASES
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GARDEN OF EDEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4168
Mailing Address - Country:US
Mailing Address - Phone:732-363-3828
Mailing Address - Fax:
Practice Address - Street 1:1400 PINE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4963
Practice Address - Country:US
Practice Address - Phone:732-363-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-26435103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst