Provider Demographics
NPI:1891559167
Name:GRINNELL, MELANIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:GRINNELL
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 1:30 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-3112
Mailing Address - Country:US
Mailing Address - Phone:207-602-9347
Mailing Address - Fax:
Practice Address - Street 1:30 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-3112
Practice Address - Country:US
Practice Address - Phone:207-602-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst