Healthcare Provider Details

I. General information

NPI: 1609446772
Provider Name (Legal Business Name): JACOB ANTHONY HARNER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W PATRICK ST
FREDERICK MD
21701-4030
US

IV. Provider business mailing address

706 W PATRICK ST
FREDERICK MD
21701-4030
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-7932
  • Fax:
Mailing address:
  • Phone: 301-882-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80417
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-11705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: