Provider Demographics
NPI:1013457639
Name:PANE, JESSICA MANCINI (M, ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MANCINI
Last Name:PANE
Suffix:
Gender:F
Credentials:M, ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5106
Mailing Address - Country:US
Mailing Address - Phone:814-221-3846
Mailing Address - Fax:
Practice Address - Street 1:228 BIRCH DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2322
Practice Address - Country:US
Practice Address - Phone:516-294-5000
Practice Address - Fax:516-294-5454
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY001749103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician