Provider Demographics
NPI:1104132257
Name:JERICHO SCHOOL FOR CHILDREN WITH AUTISM, INC.
Entity type:Organization
Organization Name:JERICHO SCHOOL FOR CHILDREN WITH AUTISM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-504-7693
Mailing Address - Street 1:PO BOX 11057
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1057
Mailing Address - Country:US
Mailing Address - Phone:904-744-5110
Mailing Address - Fax:904-744-3443
Practice Address - Street 1:1351 SPRINKLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5448
Practice Address - Country:US
Practice Address - Phone:904-744-5110
Practice Address - Fax:904-744-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty