Healthcare Provider Details

I. General information

NPI: 1952098493
Provider Name (Legal Business Name): JESSICA RIVERA ESQUIVEL BS, BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 LA-HWY 78
LIVONIA LA
70755-7075
US

IV. Provider business mailing address

4140 PRIVATE DR
TORBERT LA
70762-4217
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-3765
  • Fax:
Mailing address:
  • Phone: 225-588-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14419
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: