Healthcare Provider Details

I. General information

NPI: 1871456715
Provider Name (Legal Business Name): JACQUELINE RODRIGUEZ BCBA, LBA-NY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 5TH AVE APT 2C
NEW YORK NY
10029-1091
US

IV. Provider business mailing address

1405 5TH AVE APT 2C
NEW YORK NY
10029-1091
US

V. Phone/Fax

Practice location:
  • Phone: 954-303-9619
  • Fax:
Mailing address:
  • Phone: 954-303-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: