Provider Demographics
NPI:1326506213
Name:REPASZ, JESSICA E
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:REPASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 MONTPELIER AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1913
Mailing Address - Country:US
Mailing Address - Phone:603-620-6344
Mailing Address - Fax:
Practice Address - Street 1:208 LYNNWOOD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4313
Practice Address - Country:US
Practice Address - Phone:603-620-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003072103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1-18-34064OtherBEHAVIOR ANALYST CERTIFICATION BOARD , INC.