MEDICARE: MARISSA JEANETT CANTOR M.A., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1881112811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA JEANETT CANTOR M.A., BCBA

Provider Business Mailing Address
First Line	:	8111 SANDPIPER CIR APT 201
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-5070
Country	:	US
Telephone Number	:	813-365-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	8094 SANDPIPER CIR
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4907
Country	:	US
Telephone Number	:	410-800-4427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	09/10/2025

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