Provider Demographics
NPI:1851529416
Name:JARAMILLO, FERNANDA (MS, MS, BCBA, LCPC)
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:MS, MS, BCBA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KERSTEN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6514
Mailing Address - Country:US
Mailing Address - Phone:202-330-7780
Mailing Address - Fax:301-263-7493
Practice Address - Street 1:405 KERSTEN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6514
Practice Address - Country:US
Practice Address - Phone:202-330-7780
Practice Address - Fax:301-917-3421
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3662101YP2500X
MD1095100103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst