Provider Demographics
NPI:1508202292
Name:JARAMILLO, WHITNEY ESTELLE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ESTELLE
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ESTELLE
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1104 PINE CT SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6870
Mailing Address - Country:US
Mailing Address - Phone:505-319-0835
Mailing Address - Fax:
Practice Address - Street 1:475 COURTHOUSE RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9207
Practice Address - Country:US
Practice Address - Phone:505-319-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-18-31484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty