MEDICARE: MRS. JESSICA SIMON THENOR 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	1-2149561	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659832558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA SIMON THENOR BCBA

Provider Business Mailing Address
First Line	:	PO BOX 695141
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33269-2141
Country	:	US
Telephone Number	:	786-361-7632
Fax Number	:

Provider Business Practice Location Address
First Line	:	18640 NW 2ND AVE UNIT 695141
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33269-7100
Country	:	US
Telephone Number	:	786-361-7632
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	01/27/2025

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