Provider Demographics
NPI:1720490485
Name:MENGEL, JILL (BCBA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MENGEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19019 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3253
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-758-8015
Practice Address - Street 1:331 MONTVALE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4675
Practice Address - Country:US
Practice Address - Phone:781-281-7601
Practice Address - Fax:781-364-6209
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-07-3336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst