Provider Demographics
NPI:1508318718
Name:VILLACRESES, JAIRY
Entity Type:Individual
Prefix:
First Name:JAIRY
Middle Name:
Last Name:VILLACRESES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 PEPPERMILL TRL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8181
Mailing Address - Country:US
Mailing Address - Phone:352-255-4876
Mailing Address - Fax:352-432-5887
Practice Address - Street 1:14520 PEPPERMILL TRL
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8181
Practice Address - Country:US
Practice Address - Phone:352-255-4876
Practice Address - Fax:352-432-5887
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst