Provider Demographics
NPI:1598385775
Name:JAMBEAU, BRANDEN ROGER (MED, LBS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:BRANDEN
Middle Name:ROGER
Last Name:JAMBEAU
Suffix:
Gender:M
Credentials:MED, LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 KUTZTOWN RD SIDE 1
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2698
Mailing Address - Country:US
Mailing Address - Phone:484-650-1461
Mailing Address - Fax:
Practice Address - Street 1:3033 KUTZTOWN RD SIDE 1
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2698
Practice Address - Country:US
Practice Address - Phone:484-650-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004717103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst