Provider Demographics
NPI:1760218002
Name:FERNSTEN, JENNY (BCBA)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:FERNSTEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOYLSTON ST UNIT 990281
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-1913
Mailing Address - Country:US
Mailing Address - Phone:617-922-2370
Mailing Address - Fax:833-271-4232
Practice Address - Street 1:800 BOYLSTON ST UNIT 990281
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-1913
Practice Address - Country:US
Practice Address - Phone:617-922-2370
Practice Address - Fax:833-271-4232
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-17-26341103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst