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Individual
JACOB PATRICK FAY
Active
Individual
JACOB PATRICK FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-53551
AR
106S00000X
Behavior Technician
RBT-19-85301
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB495512
BACB ID
AR
Enumeration date
02/13/2020
Last updated
10/05/2021
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