Healthcare Provider Details

I. General information

NPI: 1083849418
Provider Name (Legal Business Name): JENNIFER DIANE CARRASQUILLO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HENRY

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WEST ORANGE STREET
LANCASTER PA
17603-3749
US

IV. Provider business mailing address

915 LITITZ AVE
LANCASTER PA
17602-1918
US

V. Phone/Fax

Practice location:
  • Phone: 717-392-8848
  • Fax: 717-397-5290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: