Provider Demographics
NPI:1114633047
Name:CRAVANAS SASSER, JLYNN CHARLISA (BEHAVIORAL HEALTH)
Entity Type:Individual
Prefix:
First Name:JLYNN
Middle Name:CHARLISA
Last Name:CRAVANAS SASSER
Suffix:
Gender:F
Credentials:BEHAVIORAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:
Practice Address - Street 1:238 13TH ST UNIT 548
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3899
Practice Address - Country:US
Practice Address - Phone:469-909-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician