Provider Demographics
NPI:1649595398
Name:ESTENSON, MELISSA ANNE (MSW,, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:ESTENSON
Suffix:
Gender:F
Credentials:MSW,, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5393 COVE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9528
Mailing Address - Country:US
Mailing Address - Phone:239-961-1803
Mailing Address - Fax:
Practice Address - Street 1:5393 COVE CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9528
Practice Address - Country:US
Practice Address - Phone:239-961-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5890103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst