Provider Demographics
NPI:1174118814
Name:DUTT MCDERMOTT, MELISSA L (BCBA, LBA, NCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:DUTT MCDERMOTT
Suffix:
Gender:F
Credentials:BCBA, LBA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 RED BRANCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9030 RED BRANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2003
Practice Address - Country:US
Practice Address - Phone:410-630-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst