Healthcare Provider Details

I. General information

NPI: 1538412366
Provider Name (Legal Business Name): JAIME MARIE GOYCO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIVER KNOLL DR
TITUSVILLE NJ
08560-1301
US

IV. Provider business mailing address

4 RIVER KNOLL DR
TITUSVILLE NJ
08560-1301
US

V. Phone/Fax

Practice location:
  • Phone: 646-238-9623
  • Fax:
Mailing address:
  • Phone: 646-238-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: