Provider Demographics
NPI:1528623089
Name:PARUNGAO, JEMIMA KEZIA QUINTANA (MA BCBA LBS LBA)
Entity type:Individual
Prefix:
First Name:JEMIMA KEZIA
Middle Name:QUINTANA
Last Name:PARUNGAO
Suffix:
Gender:F
Credentials:MA BCBA LBS LBA
Other - Prefix:
Other - First Name:JEMIMA KEZIA
Other - Middle Name:QUINTANA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:542 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:856-827-7630
Mailing Address - Fax:
Practice Address - Street 1:15000 COMMERCE PKWY STE C
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2212
Practice Address - Country:US
Practice Address - Phone:877-803-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-19-76273106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician