Provider Demographics
NPI:1285031567
Name:YOUNG, MELISSA (MED, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-4611
Mailing Address - Country:US
Mailing Address - Phone:774-573-5348
Mailing Address - Fax:
Practice Address - Street 1:67 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-4611
Practice Address - Country:US
Practice Address - Phone:774-573-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1791103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1-17-25183OtherBEHAVIOR ANALYST CERTIFICATION BOARD
MA1791OtherDIVISION OF PROFESSIONAL LICENSURE