Individual provider Active NPI

Donald Hernberg

  • Behavior Analyst
  • Willimantic, CT
National Provider Identifier
1003293572
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
082772436 Issued in CT
Practice address
356 Windham Rd
Willimantic, CT 06226-3530
Phone
(860) 301-4468
NPI assigned
May 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 082772436 CT Primary

Addresses

Primary practice location

356 Windham Rd
Willimantic, CT 06226-3530

Mailing address

356 Windham Rd
Willimantic, CT 06226-3530
Phone (860) 301-4468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
082772436CTMDBehavioral Analyst

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430697600000",
    "number": "1003293572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "356 WINDHAM RD",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062263530",
            "telephone_number": "860-301-4468",
            "fax_number": "860-456-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "356 WINDHAM RD",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062263530",
            "telephone_number": "860-301-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNBERG",
        "first_name": "DONALD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CT",
            "license": "082772436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.