Jewel Porter
Individual provider Active NPI Behavior Technician · Fort Lauderda, FL
NPI 1114579752 · NPPES record last updated Jul 14, 2019
Key facts
- NPI
- 1114579752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 1000 NW 65TH St.
Suite #201
Fort Lauderda, FL 33309 - Phone
- (855) 832-6727
- NPI assigned
- Jul 14, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
1000 NW 65TH St.
Suite #201
Fort Lauderda, FL 33309
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997-7462
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.