Provider Demographics
NPI:1770389561
Name:MINARDI, JACQUELINE (BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MINARDI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1707
Mailing Address - Country:US
Mailing Address - Phone:201-661-0085
Mailing Address - Fax:
Practice Address - Street 1:8 WRIGHT WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3121
Practice Address - Country:US
Practice Address - Phone:973-722-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12369875103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst