Healthcare Provider Details

I. General information

NPI: 1508202292
Provider Name (Legal Business Name): WHITNEY ESTELLE JARAMILLO MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WHITNEY ESTELLE ANDREWS

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 COURTHOUSE RD SE
LOS LUNAS NM
87031-9207
US

IV. Provider business mailing address

1104 PINE CT SE
LOS LUNAS NM
87031-6870
US

V. Phone/Fax

Practice location:
  • Phone: 505-319-0835
  • Fax:
Mailing address:
  • Phone: 505-319-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31484
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: