Healthcare Provider Details

I. General information

NPI: 1174010433
Provider Name (Legal Business Name): ANISSA M NEIRA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISSA M MOLLOY

II. Dates (important events)

Enumeration Date: 04/21/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E BELLE ST
HENDERSON NC
27536-4502
US

IV. Provider business mailing address

16860 EASTHAMPSTEAD RD APT 102
WINTER GARDEN FL
34787-7832
US

V. Phone/Fax

Practice location:
  • Phone: 252-272-2933
  • Fax:
Mailing address:
  • Phone: 786-234-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: