Provider Demographics
NPI:1215552534
Name:LIPOSKY, JACLYN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:LIPOSKY
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 1:12 LEGION RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3849
Mailing Address - Country:US
Mailing Address - Phone:203-906-4472
Mailing Address - Fax:
Practice Address - Street 1:12 LEGION RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3849
Practice Address - Country:US
Practice Address - Phone:203-906-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-15-19725103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst