Provider Demographics
NPI:1760842173
Name:MITCHELL, MAYA CAMILLA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:CAMILLA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27357 FRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-7306
Mailing Address - Country:US
Mailing Address - Phone:248-534-2540
Mailing Address - Fax:
Practice Address - Street 1:27357 FRAMPTON AVE # 5036
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7306
Practice Address - Country:US
Practice Address - Phone:248-534-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-50161103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician