Provider Demographics
NPI:1851871321
Name:MEREDITH, JILL (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ENGLE STREET
Mailing Address - Street 2:BUILDING 5B FLOOR 2
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-503-0995
Mailing Address - Fax:201-503-0992
Practice Address - Street 1:163 ENGLE STREET
Practice Address - Street 2:BUILDING 5B, FLOOR 2
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-503-0995
Practice Address - Fax:201-503-0992
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-9645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst