Provider Demographics
NPI:1912355835
Name:PERRIN, JENNA (BCABA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PERRIN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 LAKE DEBRA DR
Mailing Address - Street 2:APT 834
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6369
Mailing Address - Country:US
Mailing Address - Phone:407-745-1055
Mailing Address - Fax:
Practice Address - Street 1:2155 LAKE DEBRA DR
Practice Address - Street 2:APT 834
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6369
Practice Address - Country:US
Practice Address - Phone:407-745-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0156811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst