Provider Demographics
NPI:1467033787
Name:MESNICK, CASSANDRA LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:MESNICK
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 1:12650 NW 83RD LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-8666
Mailing Address - Country:US
Mailing Address - Phone:352-843-6413
Mailing Address - Fax:
Practice Address - Street 1:12650 NW 83RD LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-8666
Practice Address - Country:US
Practice Address - Phone:352-843-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107513900Medicaid