Provider Demographics
NPI:1083473771
Name:CARREON, MELISSA (RBT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARREON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 SHERMAN WAY STE 175
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3847
Mailing Address - Country:US
Mailing Address - Phone:818-991-7722
Mailing Address - Fax:818-991-7722
Practice Address - Street 1:1445 CELIS ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3207
Practice Address - Country:US
Practice Address - Phone:818-741-1299
Practice Address - Fax:818-991-7722
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-249555106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician