Provider Demographics
NPI:1992461024
Name:STANSFIELD, MELANIE (BCBA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:STANSFIELD
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 1:33 HIGHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2334
Mailing Address - Country:US
Mailing Address - Phone:203-727-0367
Mailing Address - Fax:
Practice Address - Street 1:588 NAUGATUCK AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-4059
Practice Address - Country:US
Practice Address - Phone:203-727-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1331103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst