Healthcare Provider Details

I. General information

NPI: 1770216939
Provider Name (Legal Business Name): MELANIE LYNCH LBS1, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 SW 39TH TER
CAPE CORAL FL
33914-5707
US

IV. Provider business mailing address

1118 SW 39TH TER
CAPE CORAL FL
33914-5707
US

V. Phone/Fax

Practice location:
  • Phone: 708-606-5660
  • Fax:
Mailing address:
  • Phone: 708-606-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12689406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: