Provider Demographics
NPI:1639948698
Name:ALLEN, JERIMY
Entity Type:Individual
Prefix:
First Name:JERIMY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SARATOGA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3445
Mailing Address - Country:US
Mailing Address - Phone:408-244-1743
Mailing Address - Fax:408-212-9620
Practice Address - Street 1:920 SARATOGA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3445
Practice Address - Country:US
Practice Address - Phone:408-244-1743
Practice Address - Fax:408-212-9620
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst