Provider Demographics
NPI:1316416209
Name:MARINI, JESSICA (BCABA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARINI
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TALCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2094
Mailing Address - Country:US
Mailing Address - Phone:802-662-7831
Mailing Address - Fax:802-662-7834
Practice Address - Street 1:37 TALCOTT RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2094
Practice Address - Country:US
Practice Address - Phone:802-662-7831
Practice Address - Fax:802-662-7834
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0-18-8800106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst