Healthcare Provider Details

I. General information

NPI: 1164162640
Provider Name (Legal Business Name): JENNIFER NAYBACK BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 PORTRAIT DR STE 108
CARY NC
27513
US

IV. Provider business mailing address

1005 PORTRAIT DR STE 108
CARY NC
27513
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 980-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146.0134248
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00293
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: