Provider Demographics
NPI:1902141153
Name:BRAGER, JENNIFER ALLYSON (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALLYSON
Last Name:BRAGER
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 1:4885 ROUTE 9
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6028
Mailing Address - Country:US
Mailing Address - Phone:845-889-4034
Mailing Address - Fax:
Practice Address - Street 1:4885 ROUTE 9
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6028
Practice Address - Country:US
Practice Address - Phone:845-889-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst