Provider Demographics
NPI:1104226414
Name:EATON, JENIFER LYN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:LYN
Last Name:EATON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21282 BEACH BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5720
Mailing Address - Country:US
Mailing Address - Phone:310-890-3117
Mailing Address - Fax:
Practice Address - Street 1:357 W 54TH ST
Practice Address - Street 2:#33
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5135
Practice Address - Country:US
Practice Address - Phone:310-890-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-14-15233103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-15233OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC