Provider Demographics
NPI:1477099604
Name:HAUSMAN, MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HAUSMAN
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 1:2301 MAITLAND CENTER PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7415
Mailing Address - Country:US
Mailing Address - Phone:407-574-4629
Mailing Address - Fax:407-574-3091
Practice Address - Street 1:1900 GARDEN RD STE 280
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5374
Practice Address - Country:US
Practice Address - Phone:831-220-0739
Practice Address - Fax:407-574-3091
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA1-17-25735103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst