Provider Demographics
NPI:1164666590
Name:D'ORAZIO, JESSICA S (MED, CDS, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:D'ORAZIO
Suffix:
Gender:F
Credentials:MED, CDS, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SUZANNE
Other - Last Name:KOESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2360 ROUTE 33 STE 112
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1416
Mailing Address - Country:US
Mailing Address - Phone:201-370-1782
Mailing Address - Fax:
Practice Address - Street 1:2360 ROUTE 33 STE 112
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1416
Practice Address - Country:US
Practice Address - Phone:201-370-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ602311174400000X
NJ1-17-27803103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist