Provider Demographics
NPI:1558054478
Name:BENNETT, JESSICA TAYLOR (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:TAYLOR
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WINHAM AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4930
Mailing Address - Country:US
Mailing Address - Phone:917-573-1399
Mailing Address - Fax:
Practice Address - Street 1:147 WINHAM AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4930
Practice Address - Country:US
Practice Address - Phone:917-573-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst