Provider Demographics
NPI:1265253413
Name:ESPOSITO, JASON JOHN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BLACK ALDER DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-7358
Mailing Address - Country:US
Mailing Address - Phone:630-965-2314
Mailing Address - Fax:
Practice Address - Street 1:500 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1558
Practice Address - Country:US
Practice Address - Phone:386-267-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician