Active NPI
Timothy Blackburn Jr., LABA
- Behavior Analyst
- Worcester, MA
National Provider Identifier
1154850840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 377 Shrewsbury St
Worcester, MA 01604-1632 - Phone
- (321) 987-8348
- NPI assigned
- Jun 7, 2017
- Sex
- Male
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
377 Shrewsbury St
Worcester, MA 01604-1632
Mailing address
377 Shrewsbury St
Worcester, MA 01604-1632
Phone (321) 987-8348
Other practice location 1
225 Cedar Hill St Ste 200
Marlborough, MA 01752-5900
Phone (508) 202-0506
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1154850840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "377 SHREWSBURY ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016041632",
"telephone_number": "321-987-8348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "377 SHREWSBURY ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016041632",
"telephone_number": "321-987-8348"
}
],
"practiceLocations": [
{
"address_1": "225 Cedar Hill St Ste 200",
"address_purpose": "LOCATION",
"city": "Marlborough",
"state": "MA",
"postal_code": "017525900",
"country_code": "US",
"telephone_number": "508-202-0506",
"fax_number": "508-202-0506",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACKBURN",
"first_name": "TIMOTHY",
"name_suffix": "Jr.",
"credential": "LABA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-07",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.