Provider Demographics
NPI:1528311693
Name:YANAZZO, JENNIFER KATE (MED, BCBA/LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATE
Last Name:YANAZZO
Suffix:
Gender:F
Credentials:MED, BCBA/LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SITTERLY RD.
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-899-9235
Mailing Address - Fax:
Practice Address - Street 1:23 SITTERLY RD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-899-9235
Practice Address - Fax:518-899-9315
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-5912174400000X
NY000408103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist