Individual
MS. JESSICA LYN MANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
100 SYLVAN RD STE G700, WOBURN, MA 01801-1817
(781) 569-5111
(781) 569-5112
Mailing address
30 RICH ST APT 23, MALDEN, MA 02148-7844
(617) 833-2886
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
39158
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39158
LICENSE
MA
Enumeration date
07/28/2021
Last updated
07/28/2021
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