Individual
MARISSA ANN BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
105 WINDSOR PATH STE 1, GEORGETOWN, KY 40324-9819
(859) 360-3006
Mailing address
103 WINDSOR PATH STE 2, GEORGETOWN, KY 40324-9819
(859) 757-1022
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
279522
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-60521
BCBA CREDENTIAL
KY
Enumeration date
09/27/2019
Last updated
09/03/2024
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