Provider Demographics
NPI:1295191534
Name:SOSINE, JACOB (BCBA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SOSINE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 9TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2500
Mailing Address - Country:US
Mailing Address - Phone:510-665-9700
Mailing Address - Fax:
Practice Address - Street 1:2560 9TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2500
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-15-21172OtherBACB