Provider Demographics
NPI:1306236336
Name:ANDRETTA, MELISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ANDRETTA
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 1:14 RASSMUSSEN PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1528
Mailing Address - Country:US
Mailing Address - Phone:631-875-8146
Mailing Address - Fax:
Practice Address - Street 1:14 RASSMUSSEN PL
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1528
Practice Address - Country:US
Practice Address - Phone:631-875-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-03-1217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1-03-1217OtherBEHAVIOR ANALYST CERTIFCATION BOARD
NY$$$$$$$$$OtherNYS DOE SPECIAL EDUCATION TEACHER N-12 PERMANENT CERTIFICATION