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General NPI Number Information
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NPI Number | 1811346562
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Entity Type | Individual
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Provider Name | JESSICA COSTA M.A. BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 330 SOUTH AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1325
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Country | US
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Telephone | 908-654-2476
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Fax | 908-275-8822
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Provider Business Mailing Address
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Address Line | 330 SOUTH AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1325
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Country | US
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Telephone | 908-654-2476
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Fax | 908-275-8822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-19998
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License Number State | NJ
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