Provider Demographics
NPI:1447804588
Name:JAKUBOSKI, KRISTIN N (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:JAKUBOSKI
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-0661
Mailing Address - Country:US
Mailing Address - Phone:732-784-3468
Mailing Address - Fax:
Practice Address - Street 1:34 MOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1518
Practice Address - Country:US
Practice Address - Phone:732-858-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-19-35387103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst