Individual provider Active NPI

Marissa Jaclen Henrie

  • Behavior Analyst
  • Orlando, FL
National Provider Identifier
1083139984
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
11476 S Apopka Vineland Rd Ste 118
Orlando, FL 32836-7006
Phone
(407) 955-4001
Fax
(407) 745-0738
NPI assigned
Aug 11, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

11476 S Apopka Vineland Rd Ste 118
Orlando, FL 32836-7006

Mailing address

175 Middle St Unit 1201
Lake Mary, FL 32746-3625
Phone (866) 610-0580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1083139984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 MIDDLE ST UNIT 1201",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463625",
            "telephone_number": "866-610-0580",
            "fax_number": "866-610-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11476 S APOPKA VINELAND RD STE 118",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328367006",
            "telephone_number": "407-955-4001",
            "fax_number": "407-745-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIE",
        "first_name": "MARISSA",
        "middle_name": "JACLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-11",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.