Active NPI
Jeremy Kucinski, RBT
- Behavior Technician
- Fenton, MO
National Provider Identifier
1053928077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-133899
- Practice address
- 14 Soccer Park Rd
Fenton, MO 63026-2564 - Phone
- (314) 845-3900
- Fax
- (314) 845-3901
- NPI assigned
- Sep 24, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-133899 | MO | Primary |
Addresses
Primary practice location
14 Soccer Park Rd
Fenton, MO 63026-2564
Mailing address
14 Soccer Park Rd
Fenton, MO 63026-2564
Phone (314) 845-3900
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Fenton | Direct |
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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-133899 | MO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600905600000",
"number": "1053928077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 SOCCER PARK RD",
"city": "FENTON",
"state": "MO",
"postal_code": "630262564",
"telephone_number": "314-845-3900",
"fax_number": "314-845-3901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 SOCCER PARK RD",
"city": "FENTON",
"state": "MO",
"postal_code": "630262564",
"telephone_number": "314-845-3900",
"fax_number": "314-845-3901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUCINSKI",
"first_name": "JEREMY",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-24",
"last_updated": "2020-09-24",
"certification_date": "2020-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MO",
"license": "RBT-20-133899",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Fenton",
"affiliation": "N",
"endpointDescription": "business office",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Fenton",
"address_1": "14 Soccer Park Rd",
"city": "Fenton",
"state": "MO",
"country_code": "US",
"postal_code": "630262564",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.