Provider Demographics
NPI:1215746342
Name:SUTLIFF, MAELYN JOY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MAELYN
Middle Name:JOY
Last Name:SUTLIFF
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3045
Mailing Address - Country:US
Mailing Address - Phone:540-935-7327
Mailing Address - Fax:
Practice Address - Street 1:116 W BEVERLEY ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4279
Practice Address - Country:US
Practice Address - Phone:540-332-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133004038103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst