Provider Demographics
NPI:1396359873
Name:WALKER, MELISSA MARGARET (BCBA, LBA-CT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:WALKER
Suffix:
Gender:F
Credentials:BCBA, LBA-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SEASIDE AVE UNIT 13
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4327
Mailing Address - Country:US
Mailing Address - Phone:203-240-1537
Mailing Address - Fax:
Practice Address - Street 1:14 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3915
Practice Address - Country:US
Practice Address - Phone:800-860-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT893103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-38094OtherBACB CERTIFICATION
CT893OtherLICENSED BEHAVIOR ANALYST