Provider Demographics
NPI:1083849418
Name:CARRASQUILLO, JENNIFER DIANE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DIANE
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 LITITZ AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 WEST ORANGE STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3749
Practice Address - Country:US
Practice Address - Phone:717-392-8848
Practice Address - Fax:717-397-5290
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst