Provider Demographics
NPI:1730457185
Name:MACCAFERRI, JAMIE REIS (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:REIS
Last Name:MACCAFERRI
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 OLD SANDWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2520
Mailing Address - Country:US
Mailing Address - Phone:508-930-2287
Mailing Address - Fax:
Practice Address - Street 1:1461 OLD SANDWICH RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2520
Practice Address - Country:US
Practice Address - Phone:508-930-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-08-4866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst