Provider Demographics
NPI:1174381248
Name:MILAZZO, NELLIE MELISSA (RBT)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:MELISSA
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-2923
Mailing Address - Country:US
Mailing Address - Phone:321-557-4041
Mailing Address - Fax:
Practice Address - Street 1:619 NE LIMA VIAS
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6635
Practice Address - Country:US
Practice Address - Phone:321-557-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLBACB1084676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst