Provider Demographics
NPI:1205621828
Name:CRUSOE, JAMIERA
Entity type:Individual
Prefix:
First Name:JAMIERA
Middle Name:
Last Name:CRUSOE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MERRIFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY GRANDE
Mailing Address - State:AL
Mailing Address - Zip Code:36703-2723
Mailing Address - Country:US
Mailing Address - Phone:334-419-0908
Mailing Address - Fax:334-419-0908
Practice Address - Street 1:3610 MERRIFIELD DR
Practice Address - Street 2:
Practice Address - City:VALLEY GRANDE
Practice Address - State:AL
Practice Address - Zip Code:36703-2723
Practice Address - Country:US
Practice Address - Phone:334-419-0908
Practice Address - Fax:334-419-0908
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst