Individual
MS. JAYANNA MARIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
110 CHURCH ST, PHILADELPHIA, PA 19106-2201
(267) 807-0550
Mailing address
5828 KEYSTONE ST, PHILADELPHIA, PA 19135-4204
(267) 939-8956
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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