Provider Demographics
NPI:1841579075
Name:LA BARBERA, JENNY ELLEN (PSYD, BCBA-D, LBA)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:ELLEN
Last Name:LA BARBERA
Suffix:
Gender:F
Credentials:PSYD, BCBA-D, LBA
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:ELLEN
Other - Last Name:TUZIKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, BCBA-D, LBA
Mailing Address - Street 1:510 E 23RD ST
Mailing Address - Street 2:APT. 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5012
Mailing Address - Country:US
Mailing Address - Phone:917-749-2403
Mailing Address - Fax:347-527-9170
Practice Address - Street 1:248 E 49TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1548
Practice Address - Country:US
Practice Address - Phone:917-749-2403
Practice Address - Fax:347-527-9170
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-07-3960103K00000X
NY000406103K00000X
NY018399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical