Active NPI
Diamonique Green
- Behavior Technician
- Indianapolis, IN
National Provider Identifier
1083379572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 19-84460
- Practice address
- 6865 Parkdale PL
Indianapolis, IN 46254-5654 - Phone
- (317) 299-5437
- NPI assigned
- Nov 1, 2021
- Sex
- Female
- 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 | 19-84460 | IN | Primary |
Addresses
Primary practice location
6865 Parkdale PL
Indianapolis, IN 46254-5654
Mailing address
12045 E Harvest Glen Dr
Indianapolis, IN 46229-9705
Phone (317) 401-4048
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 |
|---|---|---|---|
| 19-84460 | IN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635724800000",
"number": "1083379572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12045 E HARVEST GLEN DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462299705",
"telephone_number": "317-401-4048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6865 PARKDALE PL",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462545654",
"telephone_number": "317-299-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "DIAMONIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-01",
"last_updated": "2021-11-01",
"certification_date": "2021-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "19-84460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.