Healthcare Provider Details

I. General information

NPI: 1184193906
Provider Name (Legal Business Name): JENNA BEATRICE WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MAIN ST
WARREN RI
02885-4420
US

IV. Provider business mailing address

91 MAIN ST STE 115
WARREN RI
02885-4437
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-5651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001140
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00530
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: