Healthcare Provider Details

I. General information

NPI: 1225940950
Provider Name (Legal Business Name): JACYNTA RUANA AGBOOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ASH ST
SCRANTON PA
18510-1546
US

IV. Provider business mailing address

2000 ASH ST
SCRANTON PA
18510-1546
US

V. Phone/Fax

Practice location:
  • Phone: 570-871-4751
  • Fax: 570-955-5323
Mailing address:
  • Phone: 570-871-4751
  • Fax: 570-955-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: