Healthcare Provider Details

I. General information

NPI: 1700445269
Provider Name (Legal Business Name): JENNA NOVAK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S MAIN ST
CHESHIRE CT
06410-3432
US

IV. Provider business mailing address

4 DOGWOOD TER
NEWTOWN CT
06470-2216
US

V. Phone/Fax

Practice location:
  • Phone: 860-301-0226
  • Fax:
Mailing address:
  • Phone: 860-301-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: