Provider Demographics
NPI:1164128765
Name:MATEO, JESSICA (BCBA, LBA (CT))
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MATEO
Suffix:
Gender:F
Credentials:BCBA, LBA (CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 RICHARDS AVE APT F18
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1651
Mailing Address - Country:US
Mailing Address - Phone:203-979-7393
Mailing Address - Fax:
Practice Address - Street 1:70 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5609
Practice Address - Country:US
Practice Address - Phone:203-317-9315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1439103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst