Provider Demographics
NPI:1891136172
Name:REILLY, MELISSA ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:REILLY
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 BETHANY RD STE 92
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1669
Mailing Address - Country:US
Mailing Address - Phone:855-500-3848
Mailing Address - Fax:855-500-3848
Practice Address - Street 1:1 BETHANY RD STE 92
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1669
Practice Address - Country:US
Practice Address - Phone:855-500-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst