Provider Demographics
NPI:1659832558
Name:THENOR, JESSICA SIMON (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SIMON
Last Name:THENOR
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:PO BOX 695141
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33269-2141
Mailing Address - Country:US
Mailing Address - Phone:786-361-7632
Mailing Address - Fax:
Practice Address - Street 1:18640 NW 2ND AVE UNIT 695141
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33269-7100
Practice Address - Country:US
Practice Address - Phone:786-361-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-2149561103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019318600Medicaid