Provider Demographics
NPI:1811383037
Name:STORRS, JENNIFER (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STORRS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1092
Mailing Address - Country:US
Mailing Address - Phone:860-921-6462
Mailing Address - Fax:888-417-8523
Practice Address - Street 1:174 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7301
Practice Address - Country:US
Practice Address - Phone:757-363-8388
Practice Address - Fax:888-417-8523
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-16127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst