Provider Demographics
NPI:1174969075
Name:MARRERO, JESSICA ANN (MSED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MARRERO
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SHERIDAN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3619
Mailing Address - Country:US
Mailing Address - Phone:917-589-6849
Mailing Address - Fax:
Practice Address - Street 1:460 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5104
Practice Address - Country:US
Practice Address - Phone:917-589-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY001202-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist