Provider Demographics
NPI:1033686969
Name:LAJARA, KASSANDRA (RBT-16-17940)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:LAJARA
Suffix:
Gender:F
Credentials:RBT-16-17940
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:MANGUBAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT-16-17940
Mailing Address - Street 1:1000 PASEO CAMARILLO STE 235
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0754
Mailing Address - Country:US
Mailing Address - Phone:805-383-5566
Mailing Address - Fax:888-659-0031
Practice Address - Street 1:1000 PASEO CAMARILLO STE 235
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0754
Practice Address - Country:US
Practice Address - Phone:805-383-5566
Practice Address - Fax:888-659-0031
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-17940106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician