Provider Demographics
NPI:1629534862
Name:MAHIEU, JEANNETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:MAHIEU
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 1:392 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-9718
Mailing Address - Country:US
Mailing Address - Phone:732-966-3878
Mailing Address - Fax:609-316-5839
Practice Address - Street 1:392 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-9718
Practice Address - Country:US
Practice Address - Phone:732-966-3878
Practice Address - Fax:609-316-5839
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-33678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst