Provider Demographics
NPI:1871816439
Name:JASPER-DEMARCO, SUZANNE P (BCABA)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:P
Last Name:JASPER-DEMARCO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SAINT JOHNS ST.
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922
Mailing Address - Country:US
Mailing Address - Phone:321-639-9800
Mailing Address - Fax:321-639-6007
Practice Address - Street 1:550 SAINT JOHNS ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-639-9800
Practice Address - Fax:321-639-6007
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-04-1291103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst