Provider Demographics
NPI:1326339714
Name:STREET, JENNIFER JOYCE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOYCE
Last Name:STREET
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1124
Mailing Address - Country:US
Mailing Address - Phone:914-381-3781
Mailing Address - Fax:
Practice Address - Street 1:311 NORTH ST STE 406
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2217
Practice Address - Country:US
Practice Address - Phone:914-381-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2023-09-11
Deactivation Date:2013-02-14
Deactivation Code:
Reactivation Date:2014-03-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist