Provider Demographics
NPI:1073152609
Name:ACEVEDO-USUGA, JENNY MELISSA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MELISSA
Last Name:ACEVEDO-USUGA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BLUERIDGE DR APT M8
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1684
Mailing Address - Country:US
Mailing Address - Phone:475-235-5709
Mailing Address - Fax:
Practice Address - Street 1:8785 SW 165TH AVE # 103-104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5826
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-19-39211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty