Provider Demographics
NPI:1063085595
Name:CUTAIA, MARISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CUTAIA
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 1:1610 CLEMATIS LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2321
Mailing Address - Country:US
Mailing Address - Phone:561-389-1024
Mailing Address - Fax:
Practice Address - Street 1:1060 W STATE ROAD 434 STE 108
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4953
Practice Address - Country:US
Practice Address - Phone:407-324-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12151552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12151552OtherBCBA