Provider Demographics
NPI:1821850199
Name:JERNIGAN, ANDREA (MS ABA, BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:MS ABA, BCBA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ABA, BCBA
Mailing Address - Street 1:27 HEMENWAY RD APT B
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9738
Mailing Address - Country:US
Mailing Address - Phone:413-658-7725
Mailing Address - Fax:
Practice Address - Street 1:15 PAPINEAU ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3417
Practice Address - Country:US
Practice Address - Phone:413-262-3721
Practice Address - Fax:413-507-3363
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0134354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst