Provider Demographics
NPI:1982039939
Name:MILLER, JOCELYN (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EDGEWATER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1281
Mailing Address - Country:US
Mailing Address - Phone:617-763-8351
Mailing Address - Fax:
Practice Address - Street 1:301 EDGEWATER PL STE 100
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1281
Practice Address - Country:US
Practice Address - Phone:617-763-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst