Provider Demographics
NPI:1366982357
Name:POWERS, JACQUELYN (LBA, BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14550 YORK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9307
Mailing Address - Country:US
Mailing Address - Phone:443-330-7900
Mailing Address - Fax:
Practice Address - Street 1:14550 YORK RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9307
Practice Address - Country:US
Practice Address - Phone:443-330-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA162103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst