Provider Demographics
NPI:1992332555
Name:CRIFASI, JAKE CHARLES JR (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:CHARLES
Last Name:CRIFASI
Suffix:JR
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CAMELIA CV
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-6324
Mailing Address - Country:US
Mailing Address - Phone:985-640-8361
Mailing Address - Fax:
Practice Address - Street 1:3013 27TH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6013
Practice Address - Country:US
Practice Address - Phone:504-291-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst