Provider Demographics
NPI:1366845158
Name:PARISH, MELISSA S (MS, BCBA)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:S
Last Name:PARISH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13470 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606-2272
Mailing Address - Country:US
Mailing Address - Phone:315-408-5929
Mailing Address - Fax:
Practice Address - Street 1:22107 FABCO RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1737
Practice Address - Country:US
Practice Address - Phone:607-227-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-14-9818103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst