Provider Demographics
NPI:1114218948
Name:DOLL, JESSICA E (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:DOLL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:MAFERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33041-1577
Mailing Address - Country:US
Mailing Address - Phone:305-453-6334
Mailing Address - Fax:305-453-6374
Practice Address - Street 1:302 SOUTHARD ST STE 102
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8404
Practice Address - Country:US
Practice Address - Phone:305-453-6334
Practice Address - Fax:305-453-6374
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0279103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018456500Medicaid