Provider Demographics
NPI:1780934216
Name:DOBRES, JACQUELINE SUZANNE (MS OT R/L, BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:DOBRES
Suffix:
Gender:F
Credentials:MS OT R/L, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DREW PL
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1610
Mailing Address - Country:US
Mailing Address - Phone:732-766-5403
Mailing Address - Fax:
Practice Address - Street 1:12 DREW PL
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1610
Practice Address - Country:US
Practice Address - Phone:732-766-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-11-8606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst