Provider Demographics
NPI:1295285393
Name:MISEO, CHRISTINE ALEXIS (BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALEXIS
Last Name:MISEO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ROBERTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1650
Mailing Address - Country:US
Mailing Address - Phone:732-865-4719
Mailing Address - Fax:
Practice Address - Street 1:3826 PARK AVE
Practice Address - Street 2:# 102
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2565
Practice Address - Country:US
Practice Address - Phone:848-247-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31893103K00000X
FL0-16-7281103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst