Provider Demographics
NPI:1457783219
Name:PERRY, MELISSA (MA BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PERRY
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 1:35 SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1928
Mailing Address - Country:US
Mailing Address - Phone:631-682-0257
Mailing Address - Fax:
Practice Address - Street 1:35 SPENCE AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1928
Practice Address - Country:US
Practice Address - Phone:631-682-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-13-13817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst