Provider Demographics
NPI:1821540097
Name:TOKAREV, JESSICA R (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:TOKAREV
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:BEISANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 NAVARRE BY THE SOUND CIR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2117
Mailing Address - Country:US
Mailing Address - Phone:651-248-2706
Mailing Address - Fax:850-361-3505
Practice Address - Street 1:1825 NAVARRE BY THE SOUND CIR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2117
Practice Address - Country:US
Practice Address - Phone:651-248-2706
Practice Address - Fax:850-361-3505
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst