Healthcare Provider Details

I. General information

NPI: 1386122653
Provider Name (Legal Business Name): JESSICA TERESA MARCUS-GOMEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 PINOLE VALLEY RD STE 201
PINOLE CA
94564-1383
US

IV. Provider business mailing address

1910 POTRERO AVE
RICHMOND CA
94804-3835
US

V. Phone/Fax

Practice location:
  • Phone: 510-679-3545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: