Active NPI
Athena Jackson
- Behavior Technician
- Norwich, CT
National Provider Identifier
1104643832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 128688030
- Practice address
- 113 Salem Tpke Ste 200
Norwich, CT 06360-6484 - Phone
- (888) 754-0398
- NPI assigned
- Sep 24, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 128688030 | CT | Primary |
Addresses
Primary practice location
113 Salem Tpke Ste 200
Norwich, CT 06360-6484
Mailing address
113 Salem Tpke Ste 200
Norwich, CT 06360-6484
Other practice location 1
94 Summer St
New London, CT 06320-3513
Phone (860) 460-3784
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 |
|---|---|---|---|
| 128688030 | CT | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1104643832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 SALEM TPKE STE 200",
"city": "NORWICH",
"state": "CT",
"postal_code": "063606484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 SALEM TPKE STE 200",
"city": "NORWICH",
"state": "CT",
"postal_code": "063606484",
"telephone_number": "888-754-0398"
}
],
"practiceLocations": [
{
"address_1": "94 Summer St",
"address_purpose": "LOCATION",
"city": "New London",
"state": "CT",
"postal_code": "063203513",
"country_code": "US",
"telephone_number": "860-460-3784",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "ATHENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-24",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CT",
"license": "128688030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.