Provider Demographics
NPI:1982023834
Name:CHUNN, MARISSA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CHUNN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8016 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8751
Mailing Address - Country:US
Mailing Address - Phone:904-329-3317
Mailing Address - Fax:904-329-3318
Practice Address - Street 1:2015 DOCTORS LAKE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5410
Practice Address - Country:US
Practice Address - Phone:904-644-8632
Practice Address - Fax:904-644-8753
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-15380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst