Provider Demographics
NPI:1154029023
Name:REYES, JENNA JEAN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:JEAN
Last Name:REYES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 NW 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5028
Mailing Address - Country:US
Mailing Address - Phone:549-270-2017
Mailing Address - Fax:
Practice Address - Street 1:5361 NW 41ST WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-5028
Practice Address - Country:US
Practice Address - Phone:549-270-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-64155103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst