Provider Demographics
NPI:1932591690
Name:GARRETT, JENNA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:GARRETT
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 1:54 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2023
Mailing Address - Country:US
Mailing Address - Phone:949-903-4279
Mailing Address - Fax:
Practice Address - Street 1:54 HARVARD RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2023
Practice Address - Country:US
Practice Address - Phone:949-903-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst