Provider Demographics
NPI:1184988719
Name:PICOU, JENNIFER (BA, BCABA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:PICOU
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 CORPORATE CT STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3516
Mailing Address - Country:US
Mailing Address - Phone:239-690-5200
Mailing Address - Fax:239-690-5202
Practice Address - Street 1:6314 CORPORATE CT STE 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3516
Practice Address - Country:US
Practice Address - Phone:239-690-5200
Practice Address - Fax:239-690-5202
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-11-4064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-11-4064OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC