Provider Demographics
NPI:1093495863
Name:MELENDEZ, SAMANNTHA C (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANNTHA
Middle Name:C
Last Name:MELENDEZ
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230A PLEASANTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3405
Mailing Address - Country:US
Mailing Address - Phone:917-324-7614
Mailing Address - Fax:
Practice Address - Street 1:331 ELM ST
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1105
Practice Address - Country:US
Practice Address - Phone:908-604-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-25-80901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst