Individual provider Active NPI

Cassandra M Godwin

  • Behavior Analyst
  • Chesapeake, VA
National Provider Identifier
1164197802
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
4412 Sunray Ave
Chesapeake, VA 23321-2628
Phone
(757) 774-3000
NPI assigned
Aug 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-21-178306 VA
Behavior Analyst 103K00000X VA Primary

Addresses

Primary practice location

4412 Sunray Ave
Chesapeake, VA 23321-2628

Mailing address

4412 Sunray Ave
Chesapeake, VA 23321-2628
Phone (175) 777-4300

Other practice location 1

208 Hastings Ln
Elizabeth City, NC 27909-3324
Phone (757) 769-9595

Other practice location 2

1100 Battlefield Blvd S Ste 15309
Chesapeake, VA 23322-6619
Phone (757) 769-9595

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

LicenseStateTypeSpecialty
RBT-21-178306VAMDBehavior Technician

NPI Registry JSON

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1164197802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4412 SUNRAY AVE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212628",
            "telephone_number": "175-777-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 SUNRAY AVE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212628",
            "telephone_number": "757-774-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Hastings Ln",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279093324",
            "country_code": "US",
            "telephone_number": "757-769-9595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Battlefield Blvd S Ste 15309",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233226619",
            "country_code": "US",
            "telephone_number": "757-769-9595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODWIN",
        "first_name": "CASSANDRA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "VA",
            "license": "RBT-21-178306",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.