Provider Demographics
NPI:1437666419
Name:VERRET, JAMIE (MS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:VERRET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 N RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-1826
Mailing Address - Country:US
Mailing Address - Phone:202-977-7169
Mailing Address - Fax:
Practice Address - Street 1:2204 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-1826
Practice Address - Country:US
Practice Address - Phone:202-977-7169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCBACB306774106S00000X
DC106S00000X
FL0-21-11868106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABACB306774OtherAPPLIED BEHAVIOR ANALYSIS
FL113072700Medicaid