Provider Demographics
NPI:1932412129
Name:SUTERA, JENNIFER JEAN (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:SUTERA
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 1:1210 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3543
Mailing Address - Country:US
Mailing Address - Phone:408-706-4103
Mailing Address - Fax:408-286-1308
Practice Address - Street 1:1210 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3543
Practice Address - Country:US
Practice Address - Phone:408-706-4103
Practice Address - Fax:408-286-1308
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073309103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst