Provider Demographics
NPI:1932361276
Name:MASON, MELISSA LEIGH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WIND CHIME LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-0095
Mailing Address - Country:US
Mailing Address - Phone:954-649-4760
Mailing Address - Fax:904-587-1433
Practice Address - Street 1:134 WIND CHIME LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-0095
Practice Address - Country:US
Practice Address - Phone:954-649-4760
Practice Address - Fax:904-587-1433
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-27659103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst