Provider Demographics
NPI:1841813235
Name:YOO, JAMIE (BCBA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:YOO
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 1:118A E HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-3027
Mailing Address - Country:US
Mailing Address - Phone:201-500-8674
Mailing Address - Fax:
Practice Address - Street 1:6 MARTHA RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1406
Practice Address - Country:US
Practice Address - Phone:845-327-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-38482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst