Provider Demographics
NPI:1396255543
Name:ROE, MICHELLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROE
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 1:101 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220-3216
Mailing Address - Country:US
Mailing Address - Phone:618-381-3033
Mailing Address - Fax:
Practice Address - Street 1:101 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-3216
Practice Address - Country:US
Practice Address - Phone:618-381-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst