Provider Demographics
NPI:1790196459
Name:JODREY, MARJORIE L (BCBA)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:L
Last Name:JODREY
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 1:34 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2202
Mailing Address - Country:US
Mailing Address - Phone:732-809-5093
Mailing Address - Fax:
Practice Address - Street 1:34 EXETER ST
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2202
Practice Address - Country:US
Practice Address - Phone:732-809-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst