Provider Demographics
NPI:1326571514
Name:MARQUES, JACQUELYN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:MARQUES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 SPANISH MOSS CV
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-2114
Mailing Address - Country:US
Mailing Address - Phone:586-913-5024
Mailing Address - Fax:
Practice Address - Street 1:8245 VICELA DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1462
Practice Address - Country:US
Practice Address - Phone:239-778-7490
Practice Address - Fax:888-751-4019
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-25321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst