MEDICARE: SHELLY A JONES BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356695407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY A JONES BCBA

Provider Business Mailing Address
First Line	:	162 WEST ST STE F
Second Line	:
City	:	CROMWELL
State	:	CT
Zip	:	06416-4405
Country	:	US
Telephone Number	:	860-613-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	666 HUCKLEBERRY HILL RD
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-3233
Country	:	US
Telephone Number	:	860-841-6881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2012
Last Update Date	:	02/09/2022

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