MEDICARE: JEANNE WARD MS ED BCBA LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1255583290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE WARD MS ED BCBA LBA

Provider Business Mailing Address
First Line	:	150 97TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7602
Country	:	US
Telephone Number	:	718-238-7869
Fax Number	:

Provider Business Practice Location Address
First Line	:	7616 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2412
Country	:	US
Telephone Number	:	718-630-5100
Fax Number	:	718-491-6110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	12/13/2018

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