Basic Information
| Provider Information | |||||||||
| NPI: | 1740838002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADILLO | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 814 E MEADOW AVE | ||||||||
| Address2: | |||||||||
| City: | PINOLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305186511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6475 CHRISTIE AVE | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252561100 | ||||||||
| FaxNumber: | 9252561100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2019 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-20-46832 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.