Provider Demographics
NPI:1043572399
Name:MORENO HOOPER, JADY (MSED BCBA LBA)
Entity type:Individual
Prefix:MISS
First Name:JADY
Middle Name:
Last Name:MORENO HOOPER
Suffix:
Gender:F
Credentials:MSED BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 DUELL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3119
Mailing Address - Country:US
Mailing Address - Phone:917-292-9150
Mailing Address - Fax:
Practice Address - Street 1:35 DUELL RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3119
Practice Address - Country:US
Practice Address - Phone:917-292-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY000850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherOTHER SERVICE PROVIDER