Provider Demographics
NPI:1487366647
Name:NOUDJOM, JENNA (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:NOUDJOM
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 BEACON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5252
Mailing Address - Country:US
Mailing Address - Phone:508-542-8900
Mailing Address - Fax:
Practice Address - Street 1:1309 BEACON ST STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5252
Practice Address - Country:US
Practice Address - Phone:508-542-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst