Provider Demographics
NPI:1730584301
Name:ANDREOTTI-BLOCK, JESSICA (MA, MSED, BCBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ANDREOTTI-BLOCK
Suffix:
Gender:F
Credentials:MA, MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GARDEN CITY PLZ STE 350
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3358
Mailing Address - Country:US
Mailing Address - Phone:516-806-6969
Mailing Address - Fax:
Practice Address - Street 1:2631 MERRICK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5730
Practice Address - Country:US
Practice Address - Phone:516-590-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst