Provider Demographics
NPI:1689158388
Name:KEITH, JENNIFER LYNN (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:RICZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 FRANKLIN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1358
Mailing Address - Country:US
Mailing Address - Phone:302-604-2424
Mailing Address - Fax:302-348-8121
Practice Address - Street 1:617 FRANKLIN AVE STE 12
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1358
Practice Address - Country:US
Practice Address - Phone:302-604-2424
Practice Address - Fax:302-348-8121
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
MDLBA1617103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483106300Medicaid