Provider Demographics
NPI:1174076368
Name:LAVOIE, MELISSA LYNN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:4703 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5925
Mailing Address - Country:US
Mailing Address - Phone:302-354-5396
Mailing Address - Fax:
Practice Address - Street 1:7165 COLUMBIA GATEWAY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2539
Practice Address - Country:US
Practice Address - Phone:443-243-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000786103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45-2653391Medicaid