Provider Demographics
NPI:1437498912
Name:O'MALLEY, JENNIFER (BCBA, LEP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:BCBA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41769 ENTERPRISE CIR N
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5626
Mailing Address - Country:US
Mailing Address - Phone:951-719-3738
Mailing Address - Fax:
Practice Address - Street 1:41769 ENTERPRISE CIR N
Practice Address - Street 2:SUITE 101 A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5626
Practice Address - Country:US
Practice Address - Phone:951-719-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA3427103T00000X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool