Tia Kaysaundra Johnson, BCBA 1-19-38888

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

1753 Meriden Wtby Tpke
Milldale, CT 06467-6508

Phone

(203) 558-0367

NPI assigned

Mar 6, 2018

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 8, 2023.

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1013419977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BRIMFIELD RD",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061093205",
            "telephone_number": "951-813-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1753 MERIDEN WTBY TPKE",
            "city": "MILLDALE",
            "state": "CT",
            "postal_code": "064676508",
            "telephone_number": "203-558-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIA",
        "middle_name": "KAYSAUNDRA",
        "name_prefix": "Mrs.",
        "credential": "BCBA 1-19-38888",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-06",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF PUBLIC HEALTH",
            "identifier": "1353",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Milldale, CT
• Behavior Analyst in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.