Provider Demographics
NPI:1164837167
Name:KEREMES, JAROD (BCABA)
Entity Type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:KEREMES
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 GLOVER LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4556
Mailing Address - Country:US
Mailing Address - Phone:850-626-0606
Mailing Address - Fax:850-361-3443
Practice Address - Street 1:4891 GLOVER LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4556
Practice Address - Country:US
Practice Address - Phone:850-626-0606
Practice Address - Fax:850-361-3443
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-14-6040106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-14-6040OtherBACB