Provider Demographics
NPI:1053993410
Name:CAENEPEEL, MISTY MARIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MARIE
Last Name:CAENEPEEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MARIE
Other - Last Name:MAJEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2270 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-444-5649
Mailing Address - Fax:888-265-7858
Practice Address - Street 1:2270 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-444-5649
Practice Address - Fax:888-265-7858
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1-20-44602OtherBACB CERTIFICATE