Provider Demographics
NPI:1083066443
Name:LANE, JESSICA (MS LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MS LBA, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:REICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 CHELSEA PLACE, P.O. BOX 405
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-982-1886
Mailing Address - Fax:518-734-0276
Practice Address - Street 1:6 CHELSEA PLACE
Practice Address - Street 2:SUITE 202
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-982-1886
Practice Address - Fax:518-734-0276
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst