Healthcare Provider Details

I. General information

NPI: 1518858778
Provider Name (Legal Business Name): JENNA PEREZ BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 ENTERPRISE PKWY
RICHMOND VA
23294-6343
US

IV. Provider business mailing address

2727 ENTERPRISE PKWY
RICHMOND VA
23294-6343
US

V. Phone/Fax

Practice location:
  • Phone: 804-372-0151
  • Fax: 804-912-2163
Mailing address:
  • Phone: 804-372-0151
  • Fax: 804-912-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004426
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: