Provider Demographics
NPI:1881910503
Name:JENSEN, MARIANNE (BCBA)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:JENSEN
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 1:3715 MAIN ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3618
Mailing Address - Country:US
Mailing Address - Phone:203-373-1696
Mailing Address - Fax:203-373-9305
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3618
Practice Address - Country:US
Practice Address - Phone:203-373-1696
Practice Address - Fax:203-373-9305
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-05-2282103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst