Provider Demographics
NPI:1205671401
Name:CIRU, JASMINE (RBT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CIRU
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2211
Mailing Address - Country:US
Mailing Address - Phone:321-346-8450
Mailing Address - Fax:
Practice Address - Street 1:3880 CATALINA ST FL 32796
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2211
Practice Address - Country:US
Practice Address - Phone:321-346-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-357636106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123826700Medicaid