Jessica Chan, MS.ED., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BACB526371

Practice address

4917 170TH St
Fresh Meadows, NY 11365-1012

Phone

(646) 549-6291

NPI assigned

Jan 5, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Excel Together Licensed Behavior Analysis, PLLC

  • Community/Behavioral Health Agency
  • Whitestone, NY
  • NPI 1720818230
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1033707153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4917 170TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651012",
            "telephone_number": "646-549-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4917 170TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651012",
            "telephone_number": "646-549-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JESSICA",
        "credential": "MS.ED., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "BACB526371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francesca Remi Cencioni
• Vanessa Cespedes
• Edward N. Chai, M.D.
• Nikki Annette Chamblee, LMSW
• Pui Fong Chan Mei, PT
• Susanna Chan, OTR/L
• Winnie Chan
• Woon Yee Kiki Chan
• Marcella S Chander, OTR/L.,PTA
• David Tsan-Rue Chang, L. AC.

• Behavior Analyst in Fresh Meadows, NY
• Providers in Fresh Meadows, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.