Provider Demographics
NPI:1831436617
Name:HEANEY, JENNIFER R (MSED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:HEANEY
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOXBORO RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3810
Mailing Address - Country:US
Mailing Address - Phone:631-591-1682
Mailing Address - Fax:
Practice Address - Street 1:8 FOXBORO RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3810
Practice Address - Country:US
Practice Address - Phone:631-591-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY493706111174400000X
NY433260101174400000X
NY000957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist