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NPI Code Detail

MEDICARE: LACHANDIA JIMERSON

MEDICARE: LACHANDIA JIMERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1760345219
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACHANDIA JIMERSON
Provider Business Mailing Address
First Line : 1051 W 26TH ST
Second Line :
City : RIVIERA BEACH
State : FL
Zip : 33404-4117
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N MILITARY TRL STE 304
Second Line :
City : BOCA RATON
State : FL
Zip : 33431-6324
Country : US
Telephone Number : 772-362-9878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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Directions to “ LACHANDIA JIMERSON ” Practice Location

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