Provider Demographics
NPI:1740721109
Name:CONTI, MICHELLE (BCBA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CONTI
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 1:107 STANDISH DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1749
Mailing Address - Country:US
Mailing Address - Phone:315-480-6799
Mailing Address - Fax:
Practice Address - Street 1:107 STANDISH DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1749
Practice Address - Country:US
Practice Address - Phone:315-480-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000187-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst