Provider Demographics
NPI:1245872373
Name:ZION-ZAGRODNY, JESSICA LAURIE (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAURIE
Last Name:ZION-ZAGRODNY
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CTR
Mailing Address - State:CT
Mailing Address - Zip Code:06259-1500
Mailing Address - Country:US
Mailing Address - Phone:860-933-1846
Mailing Address - Fax:
Practice Address - Street 1:67 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:POMFRET CTR
Practice Address - State:CT
Practice Address - Zip Code:06259-1500
Practice Address - Country:US
Practice Address - Phone:860-933-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2807-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst