Provider Demographics
NPI:1245772789
Name:FAJARDO, ELIZABETH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ROCKMEAD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2294
Mailing Address - Country:US
Mailing Address - Phone:281-793-8980
Mailing Address - Fax:
Practice Address - Street 1:611 ROCKMEAD DR STE 100
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2294
Practice Address - Country:US
Practice Address - Phone:281-793-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst