Provider Demographics
NPI:1699257667
Name:WEBER, JACQUELINE J (BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:WEBER
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 1:2600 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8638
Mailing Address - Country:US
Mailing Address - Phone:570-575-3893
Mailing Address - Fax:
Practice Address - Street 1:2600 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8638
Practice Address - Country:US
Practice Address - Phone:570-575-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst