Provider Demographics
NPI:1639666431
Name:IYER, SVETLANA KONONENKO (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:KONONENKO
Last Name:IYER
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 1:33 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1153
Mailing Address - Country:US
Mailing Address - Phone:973-765-4774
Mailing Address - Fax:
Practice Address - Street 1:51 GLEN RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1152
Practice Address - Country:US
Practice Address - Phone:973-765-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-11-8448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst