Individual
KIMBERLY RITA JACARUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2210 MIGUEL CHAVEZ RD UNIT 123, SANTA FE, NM 87505-6933
(508) 353-0361
Mailing address
2210 MIGUEL CHAVEZ RD UNIT 123, SANTA FE, NM 87505-6933
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BUO960868252
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/26/2018
Last updated
01/26/2018
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