Provider Demographics
NPI:1013361344
Name:BRUCE, MELISSA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 MOCKINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4632
Mailing Address - Country:US
Mailing Address - Phone:202-868-3693
Mailing Address - Fax:808-524-8186
Practice Address - Street 1:200 N VINEYARD BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3950
Practice Address - Country:US
Practice Address - Phone:808-523-8188
Practice Address - Fax:808-524-8186
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27429103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst