Provider Demographics
NPI:1093500282
Name:MITZA, MADISON CALABRIA (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:CALABRIA
Last Name:MITZA
Suffix:
Gender:
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORMA DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1340
Mailing Address - Country:US
Mailing Address - Phone:603-769-0524
Mailing Address - Fax:
Practice Address - Street 1:20A NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4066
Practice Address - Country:US
Practice Address - Phone:603-305-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-24-77476103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst