Individual provider Active NPI

Bethany Lynn Badder

  • Behavior Technician
  • Port St Lucie, FL
National Provider Identifier
1144988049
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
1887 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5530
Phone
(772) 463-0444
Fax
(772) 219-1339
NPI assigned
Dec 8, 2021
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X FL Primary

Addresses

Primary practice location

1887 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5530

Mailing address

727 Cheyenne Ave
Melbourne, FL 32935-2621
Phone (772) 463-0444

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

Practice roles

OrganizationSpecialtyStatusNew patients
Behavior Basics, Incorporated CurrentSince Oct 23, 2022 Accepting new patients
Behavior Basics, Incorporated CurrentSince Oct 23, 2022 Accepting new patients
The Sonder Academy PastSince Dec 1, 2021 Accepting new patients

Locations

1887 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 219-1339

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1144988049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 CHEYENNE AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352621",
            "telephone_number": "772-463-0444",
            "fax_number": "772-219-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1887 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525530",
            "telephone_number": "772-463-0444",
            "fax_number": "772-219-1339"
        }
    ],
    "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": "BADDER",
        "first_name": "BETHANY",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-08",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.