Provider Demographics
NPI:1861738338
Name:SCALISE, MALENA DAWN (MA BCBA)
Entity type:Individual
Prefix:MRS
First Name:MALENA
Middle Name:DAWN
Last Name:SCALISE
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1328
Mailing Address - Country:US
Mailing Address - Phone:304-546-0897
Mailing Address - Fax:
Practice Address - Street 1:538 3RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1328
Practice Address - Country:US
Practice Address - Phone:304-546-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11212563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11212563OtherBCBA CERTIFICATION