Individual
JESSICA LEANNE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA-NY
Contact information
Practice address
128 W 95TH ST, NEW YORK, NY 10025-6604
(646) 480-5756
Mailing address
128 W 95TH ST, NEW YORK, NY 10025-6604
(646) 480-5756
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
001399
NY
Other
Enumeration date
03/20/2018
Last updated
03/20/2018
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