Provider Demographics
NPI:1063922011
Name:CRABTREE, MELISSA ANN (BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:CRABTREE
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 1:962 PEWTER ROCK
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-9687
Mailing Address - Country:US
Mailing Address - Phone:716-338-7769
Mailing Address - Fax:
Practice Address - Street 1:962 PEWTER ROCK
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-9687
Practice Address - Country:US
Practice Address - Phone:716-338-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst