Provider Demographics
NPI:1164702692
Name:GOICOECHEA, JASLIN ASHLEY (BCABA)
Entity Type:Individual
Prefix:MS
First Name:JASLIN
Middle Name:ASHLEY
Last Name:GOICOECHEA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 PALMDALE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7184
Mailing Address - Country:US
Mailing Address - Phone:407-716-2388
Mailing Address - Fax:
Practice Address - Street 1:2695 CYPRESS HEAD TRL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7381
Practice Address - Country:US
Practice Address - Phone:407-375-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-11-4156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst