Provider Demographics
NPI:1639811631
Name:ESPAILLAT, JESSICA FAICHA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAICHA
Last Name:ESPAILLAT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 3RD ST APT A1
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2764
Mailing Address - Country:US
Mailing Address - Phone:321-945-0044
Mailing Address - Fax:
Practice Address - Street 1:290 3RD ST APT A1
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2764
Practice Address - Country:US
Practice Address - Phone:321-945-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129119106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician