Provider Demographics
NPI:1922663202
Name:VAUGHAN, JARROD (BCBA)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3727
Mailing Address - Country:US
Mailing Address - Phone:816-588-7163
Mailing Address - Fax:
Practice Address - Street 1:640 NORTH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2415
Practice Address - Country:US
Practice Address - Phone:757-967-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst