Provider Demographics
NPI:1033742630
Name:RAMOS, JACQUELINE R (BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:RAMOS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 VINEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8031
Mailing Address - Country:US
Mailing Address - Phone:361-720-0355
Mailing Address - Fax:
Practice Address - Street 1:900 N CUERNAVACA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-3218
Practice Address - Country:US
Practice Address - Phone:512-772-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty