Provider Demographics
NPI:1740909019
Name:REIFSCHNEIDER, MARISA MARGARET (BCBA)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:MARGARET
Last Name:REIFSCHNEIDER
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 1:130 DALTON ST
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1145
Mailing Address - Country:US
Mailing Address - Phone:203-885-2421
Mailing Address - Fax:
Practice Address - Street 1:737 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2624
Practice Address - Country:US
Practice Address - Phone:203-525-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1195103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst