Marisa Alexis Mitchem, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-16-24251 Issued in FL

Practice address

13538 Village Park Dr
Orlando, FL 32837-7698

Phone

(407) 730-2948

NPI assigned

Feb 7, 2018

Last updated

Feb 7, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Metamorphosis Therapy LLC

  • Behavior Technician
  • Winter Garden, FL
  • NPI 1477008407
  NPD
• Metamorphosis Therapy, LLC

  • Speech-Language Pathologist
  • Winter Garden, FL
  • NPI 1942519103
  NPD

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517961600000",
    "number": "1811496508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 N WESTMORELAND DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328043638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13538 VILLAGE PARK DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328377698",
            "telephone_number": "407-730-2948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHEM",
        "first_name": "MARISA",
        "middle_name": "ALEXIS",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-16-24251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019823300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Quinby Mitchell
• Scott Mitchell, LCSW
• Tachianna Mitchell, APRN
• Temica Rachelle Mitchell
• Thomas R. Mitchell, M.S., CCC/A, FAAA
• Rachel Mitchem
• Angela Delfina Aquino Mitra Perez, APRN
• Rajorshi Mitra, M.D.
• Stefano Themio Mitsakis
• Melanie Mitta, M.D

• Behavior Technician in Orlando, FL
• Providers in Orlando, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; 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.