Provider Demographics
NPI:1558850966
Name:BORRELLI, JACLYN (BCBA)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E GENERAL STEWART WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2636
Mailing Address - Country:US
Mailing Address - Phone:877-321-2899
Mailing Address - Fax:877-540-0182
Practice Address - Street 1:740 E GENERAL STEWART WAY STE 103
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2636
Practice Address - Country:US
Practice Address - Phone:877-321-2899
Practice Address - Fax:877-540-0182
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-18-54233106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician