Active NPI
Ebene Jackson, RBT
- Behavior Technician
- Brandon, FL
National Provider Identifier
1104558451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-338443
- Practice address
- 220 Grand Regency Blvd
Brandon, FL 33510-3935 - Phone
- (813) 709-7989
- NPI assigned
- Jun 27, 2022
- 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 | RBT-24-338443 | FL | Primary |
Addresses
Primary practice location
220 Grand Regency Blvd
Brandon, FL 33510-3935
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Other practice location 1
475 S John Rodes Blvd
Melbourne, FL 32904-1093
Phone (321) 241-1170
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-24-338443 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Sonder Academy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Melbourne, FL
- NPI 1023549680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712102400000",
"number": "1104558451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 GRAND REGENCY BLVD",
"city": "BRANDON",
"state": "FL",
"postal_code": "335103935",
"telephone_number": "813-709-7989"
}
],
"practiceLocations": [
{
"address_1": "475 S John Rodes Blvd",
"address_purpose": "LOCATION",
"city": "Melbourne",
"state": "FL",
"postal_code": "329041093",
"country_code": "US",
"telephone_number": "321-241-1170",
"fax_number": "321-241-1171",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "EBENE",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-27",
"last_updated": "2024-04-03",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-338443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.