Individual
MS. JAZMYN S SOURYAMAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LABA
Contact information
Practice address
35 WALL ST APT C, WORCESTER, MA 01604-3746
(231) 499-4636
Mailing address
35 WALL ST APT C, WORCESTER, MA 01604-3746
(231) 499-4636
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3482
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15189471
CAQH
MA
Enumeration date
07/19/2021
Last updated
07/19/2021
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