Provider Demographics
NPI:1255010963
Name:METRITIKAS, JENNA MARIE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MARIE
Last Name:METRITIKAS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NORTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5609
Mailing Address - Country:US
Mailing Address - Phone:203-202-3153
Mailing Address - Fax:
Practice Address - Street 1:70 NORTH ST STE 103
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5609
Practice Address - Country:US
Practice Address - Phone:203-202-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst