Provider Demographics
NPI:1881263077
Name:PENNINGTON, JACQUELINE ELISE (RBT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELISE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4052
Mailing Address - Country:US
Mailing Address - Phone:484-639-7778
Mailing Address - Fax:
Practice Address - Street 1:46 MYSTERY ROSE LN
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8812
Practice Address - Country:US
Practice Address - Phone:610-316-7307
Practice Address - Fax:610-436-1208
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-82909OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)