Provider Demographics
NPI:1073997284
Name:GUTMANN, JESSICA LYNN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:GUTMANN
Suffix:
Gender:
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIGEON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9607
Mailing Address - Country:US
Mailing Address - Phone:631-445-5265
Mailing Address - Fax:
Practice Address - Street 1:1 PIGEON RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9607
Practice Address - Country:US
Practice Address - Phone:631-445-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NY004271103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool