Provider Demographics
NPI:1922482082
Name:OSORTO, JENNIFER C (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:OSORTO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CAROLYN TER APT A
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2866
Mailing Address - Country:US
Mailing Address - Phone:908-425-5638
Mailing Address - Fax:
Practice Address - Street 1:125 HALF MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6749
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ1-20-41502103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program