Provider Demographics
NPI:1962894386
Name:SADAVOY, JACOB AARON (BCBA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:AARON
Last Name:SADAVOY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WEST LAKE DRIVE
Mailing Address - Street 2:25
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5127
Mailing Address - Country:US
Mailing Address - Phone:917-938-8097
Mailing Address - Fax:
Practice Address - Street 1:402 WEST LAKE DRIVE
Practice Address - Street 2:25
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5127
Practice Address - Country:US
Practice Address - Phone:917-938-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71000704103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst