Provider Demographics
NPI:1154993954
Name:JARA, GABRIELLA (BCBA)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:JARA
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 1:81 FERN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2216
Mailing Address - Country:US
Mailing Address - Phone:203-444-4085
Mailing Address - Fax:
Practice Address - Street 1:705 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1412
Practice Address - Country:US
Practice Address - Phone:860-233-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst