Provider Demographics
NPI:1588124507
Name:MITTON, JENNIFER LYNNE (MA, LBS, BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:MITTON
Suffix:
Gender:F
Credentials:MA, LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:1407 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9000
Practice Address - Country:US
Practice Address - Phone:717-845-2482
Practice Address - Fax:717-843-2170
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PABH004210103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH004210OtherSTATE LICENSE - BEHAVIOR SPECIALIST