Provider Demographics
NPI:1407631625
Name:CAREY, JAMIE (LEP, BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:LEP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 GLENCLIFF ST APT 83
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6456
Mailing Address - Country:US
Mailing Address - Phone:702-423-1976
Mailing Address - Fax:
Practice Address - Street 1:4695 MACARTHUR CT
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1882
Practice Address - Country:US
Practice Address - Phone:949-490-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11819103K00000X
CA4362103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst