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General NPI Number Information
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NPI Number | 1982023834
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Entity Type | Individual
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Provider Name | MARISSA CHUNN BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 2015 DOCTORS LAKE DR
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City | ORANGE PARK
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State | FL
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Zip | 32073-5410
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Country | US
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Telephone | 904-644-8632
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Fax | 904-644-8753
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Provider Business Mailing Address
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Address Line | 8016 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-8751
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Country | US
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Telephone | 904-329-3317
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Fax | 904-329-3318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-15380
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License Number State | FL
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