Healthcare Provider Details

I. General information

NPI: 1194241059
Provider Name (Legal Business Name): MARISSA PERRI GERAGHTY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA PERRI BCBA

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 N SUN DR STE 112
LAKE MARY FL
32746-2599
US

IV. Provider business mailing address

1509 E COLONIAL DR STE 300
ORLANDO FL
32803-4729
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-5429
  • Fax: 321-800-7201
Mailing address:
  • Phone: 407-317-5429
  • Fax: 321-800-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62247
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: