Provider Demographics
NPI:1609281799
Name:MCAVOY, JENNIFER (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 MAIN ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5802
Mailing Address - Country:US
Mailing Address - Phone:207-212-6848
Mailing Address - Fax:207-783-7474
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:SUITE 19
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5802
Practice Address - Country:US
Practice Address - Phone:207-212-6848
Practice Address - Fax:207-783-7474
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-14-16486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst