Provider Demographics
NPI:1700439957
Name:NIEBUHR, JENNIFER JUNE (BCABA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUNE
Last Name:NIEBUHR
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JUNE
Other - Last Name:GENOVESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCABA
Mailing Address - Street 1:935 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3101
Mailing Address - Country:US
Mailing Address - Phone:757-428-3367
Mailing Address - Fax:
Practice Address - Street 1:935 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3101
Practice Address - Country:US
Practice Address - Phone:757-428-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
VA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician