Healthcare Provider Details

I. General information

NPI: 1275835175
Provider Name (Legal Business Name): MRS. LAURIE JEAN JARUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2010
Last Update Date: 11/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 BLUEJAY LN
EAST TAUNTON MA
02718-5130
US

IV. Provider business mailing address

126 BLUEJAY LN
EAST TAUNTON MA
02718-5130
US

V. Phone/Fax

Practice location:
  • Phone: 508-821-9643
  • Fax:
Mailing address:
  • Phone: 508-821-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberS67139123
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: