Provider Demographics
NPI:1487064176
Name:HENNEMUTH, MELISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HENNEMUTH
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 1:1 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1643
Mailing Address - Country:US
Mailing Address - Phone:401-270-7110
Mailing Address - Fax:877-745-3538
Practice Address - Street 1:1 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1643
Practice Address - Country:US
Practice Address - Phone:401-270-7110
Practice Address - Fax:877-745-3538
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst