Provider Demographics
NPI:1306268289
Name:COOK, MELISSA (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LAKE SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034
Mailing Address - Country:US
Mailing Address - Phone:908-591-7589
Mailing Address - Fax:
Practice Address - Street 1:179 LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034
Practice Address - Country:US
Practice Address - Phone:908-591-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-10-6839103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst