Provider Demographics
NPI:1801690110
Name:RAMIREZ, JENNIFER V (MA NCSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:V
Last Name:RAMIREZ
Suffix:
Gender:
Credentials:MA NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N 74TH ST UNIT 153
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7419
Mailing Address - Country:US
Mailing Address - Phone:832-248-6751
Mailing Address - Fax:
Practice Address - Street 1:205 N 74TH ST UNIT 153
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-7419
Practice Address - Country:US
Practice Address - Phone:832-248-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP0000001196596103TS0200X
AZ6109844103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool