Samantha De Vasconcelos

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-24-76279 Issued in MA

Practice address

147 Pelham St Ste 201
Methuen, MA 01844-2060

Phone

(617) 402-5444

NPI assigned

Oct 20, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Samantha Fernandez Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Applied Behavior Institute LLC

  • Community/Behavioral Health Agency
  • Marlborough, MA
  • NPI 1679114474
  NPD (past)
• Arms Wide Open NH LLC

  • Behavior Analyst
  • Portsmouth, NH
  • NPI 1851125090
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731196800000",
    "number": "1124627211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CEDAR HILL ST STE 200",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017525900",
            "telephone_number": "857-829-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 PELHAM ST STE 201",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018442060",
            "telephone_number": "617-402-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VASCONCELOS",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "1-24-76279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "FERNANDEZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David I Kahan OD PC
• Kira Davis
• Ryan Scott Davis, PHARMD
• Sherrill A Davis, MD
• Gabriela De Andrade
• Angelique Lyons Decoste, CCC-SLP
• Joslyn Defeo
• Degre Chiropractic of Methuen LLC
• Ashanna Del Rosario
• Aracelis Delacruz, RN

• All providers in Methuen, MA
• Behavior Analyst in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.

Verify at the official NPI Registry.