Jennifer Cathryn Dewey, RBT
Individual provider Active NPI Community/Behavioral Health Agency · Copperopolis, CA
NPI 1194459206 · NPPES record last updated Jul 13, 2022
Key facts
- NPI
- 1194459206
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 1052377 (FL)
- Practice address
- 3120 Salmon Rd
Copperopolis, CA 95228-9433 - Phone
- (575) 405-8842
- NPI assigned
- Jul 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1052377 | FL | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 1052377 | FL | Yes |
Addresses
Primary practice location
3120 Salmon Rd
Copperopolis, CA 95228-9433
Mailing address
3120 Salmon Rd
Copperopolis, CA 95228-9433
Phone (575) 405-8842
Other practice location 1
7108 S Kanner Hwy
Stuart, FL 34997-7462
Phone (855) 832-6727
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700024296 | Other | POSITIVE BEHAVIOR SUPPORTS CORPORATION |
Other providers in Copperopolis, CA
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- Copperopolis Pharmacy
- Mark Scott Demanes
- Polly Chrysanthemum Dodds
- Emotional and Behavioral Helath Services
- Richard Wesley French
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- Kirandeep Kaur
All providers in Copperopolis, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. 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.