Provider Demographics
NPI:1356809537
Name:GENDREAU, JENNIFER MAE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODSIDE GRN APT 2A
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4908
Mailing Address - Country:US
Mailing Address - Phone:203-803-9946
Mailing Address - Fax:
Practice Address - Street 1:339 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3560
Practice Address - Country:US
Practice Address - Phone:203-799-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT551103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst