Provider Demographics
NPI:1154170421
Name:POWELL, MELISA ROYA (BCBA, LBA-CT)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:ROYA
Last Name:POWELL
Suffix:
Gender:F
Credentials:BCBA, LBA-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BROADWAY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1052
Mailing Address - Country:US
Mailing Address - Phone:860-245-1519
Mailing Address - Fax:860-969-4552
Practice Address - Street 1:121 BROADWAY ST STE 4
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1052
Practice Address - Country:US
Practice Address - Phone:860-245-1519
Practice Address - Fax:860-969-4552
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst