Provider Demographics
NPI:1417407784
Name:HARRIS, JENNIFER L (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PETKOVSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MELANIE LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2080
Mailing Address - Country:US
Mailing Address - Phone:908-581-6862
Mailing Address - Fax:
Practice Address - Street 1:16 MELANIE LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2080
Practice Address - Country:US
Practice Address - Phone:908-581-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22405103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst