Provider Demographics
NPI:1841817608
Name:BURTO, JENNIFER LYNN (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BURTO
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 HUDSON CIR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-6554
Mailing Address - Country:US
Mailing Address - Phone:954-549-4888
Mailing Address - Fax:
Practice Address - Street 1:601 CATOCTIN CIR NE BLDG 581
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4964
Practice Address - Country:US
Practice Address - Phone:703-857-2157
Practice Address - Fax:703-777-1935
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
VA0133002308103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician