Marissa Ann Brandon, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

279522 Issued in KY

Practice address

105 Windsor Path Ste 1
Georgetown, KY 40324-9819

Phone

(859) 360-3006

NPI assigned

Sep 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: marissa.thompson@cultivatebhe.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bluegrass Behavioral Health Group, LLC

  • Behavior Analyst
  • Edgewood, KY
  • NPI 1952840860
  NPD (past)

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1326699646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 WINDSOR PATH STE 2",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249819",
            "telephone_number": "859-757-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WINDSOR PATH STE 1",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249819",
            "telephone_number": "859-360-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDON",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "KY",
            "license": "279522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA CREDENTIAL",
            "identifier": "1-22-60521",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Marissa.Thompson@cultivatebhe.com",
            "affiliation": "Y",
            "affiliationName": "Cultivate Behavioral Health & Education",
            "address_1": "105 Windsor Path Ste 1",
            "city": "Georgetown",
            "state": "KY",
            "country_code": "US",
            "postal_code": "403249819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brett Bowman, PT
• Zoe Elizabeth-Jean Box, MS, LAT, ATC
• Doreen Diana Brabble
• Michael S Bradley, PA-C
• Shari L Bradley, LMSW
• Tonya R Branham, LPCC, LMHC, LPC
• Nathan Brashear, PHARMD
• Kristen Leigh Bretz, ATC
• Tiffany Danielle Brewer, AU.D.
• Anna Faith Bridges

• All providers in Georgetown, KY
• Behavior Analyst in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.