Provider Demographics
NPI:1205529088
Name:CAJIGAS, JALISA CHELSEA
Entity type:Individual
Prefix:
First Name:JALISA
Middle Name:CHELSEA
Last Name:CAJIGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JALISA
Other - Middle Name:CHELSEA
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 MATHER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2374
Mailing Address - Country:US
Mailing Address - Phone:860-268-5424
Mailing Address - Fax:
Practice Address - Street 1:119 MATHER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2374
Practice Address - Country:US
Practice Address - Phone:860-268-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician