Healthcare Provider Details

I. General information

NPI: 1184388787
Provider Name (Legal Business Name): JACQUELINE MARIE ESPOSITO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BEACH 116TH ST
ROCKAWAY PARK NY
11694-2430
US

IV. Provider business mailing address

65 GALLOWAY AVE
STATEN ISLAND NY
10302-2527
US

V. Phone/Fax

Practice location:
  • Phone: 347-674-8733
  • Fax:
Mailing address:
  • Phone: 917-273-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: