Provider Demographics
NPI:1669159018
Name:MERRY, MAKAYLA BRYN (BCBA)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:BRYN
Last Name:MERRY
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 1:396 GRIFFIN RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3023
Mailing Address - Country:US
Mailing Address - Phone:207-573-1000
Mailing Address - Fax:
Practice Address - Street 1:396 GRIFFIN RD UNIT 106
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3023
Practice Address - Country:US
Practice Address - Phone:207-573-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-22-62067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst