Provider Demographics
NPI:1598109340
Name:WONG, JESSIE WUIYI (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:WUIYI
Last Name:WONG
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OLD SHERMAN TPKE STE 200
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-429-5318
Mailing Address - Fax:203-628-4388
Practice Address - Street 1:7 OLD SHERMAN TPKE STE 200
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-429-5318
Practice Address - Fax:203-628-4388
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001011103K00000X
CT11312883103K00000X
CT0094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst