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NPI Code Detail

MEDICARE: JACLYN BORRELLI BCBA

MEDICARE: JACLYN BORRELLI 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
1106S00000XBehavior TechnicianRBT-18-54233GA
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1558850966
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN BORRELLI BCBA
Provider Business Mailing Address
First Line : 740 E GENERAL STEWART WAY STE 103
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2636
Country : US
Telephone Number : 877-321-2899
Fax Number : 877-540-0182
Provider Business Practice Location Address
First Line : 740 E GENERAL STEWART WAY STE 103
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2636
Country : US
Telephone Number : 877-321-2899
Fax Number : 877-540-0182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2018
Last Update Date : 12/19/2022

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