Provider Demographics
NPI:1093254039
Name:FENSKE, MELISSA (BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FENSKE
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 1:825 GEORGES RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3357
Mailing Address - Country:US
Mailing Address - Phone:732-227-4050
Mailing Address - Fax:855-372-9976
Practice Address - Street 1:825 GEORGES RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3357
Practice Address - Country:US
Practice Address - Phone:732-227-4050
Practice Address - Fax:855-372-9976
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-12768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst