Provider Demographics
NPI:1619768850
Name:FAJARDO, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:FAJARDO
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 1:6321 GRANT CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5939
Mailing Address - Country:US
Mailing Address - Phone:786-370-5724
Mailing Address - Fax:
Practice Address - Street 1:6321 GRANT CT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5939
Practice Address - Country:US
Practice Address - Phone:786-370-5724
Practice Address - Fax:786-370-5724
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician