Provider Demographics
NPI:1548624844
Name:JAMROG, HALEY MARIE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:JAMROG
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LINGER LONGER DRIVE
Mailing Address - Street 2:APT 3301
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455
Mailing Address - Country:US
Mailing Address - Phone:860-951-9267
Mailing Address - Fax:
Practice Address - Street 1:530 LINGER LONGER DR UNIT 3301
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-3198
Practice Address - Country:US
Practice Address - Phone:860-951-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty