Raven Cord

Key facts

NPI

1194580167

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

Practice address

4107 Mitscher CT
Kensington, MD 20895-1307

Phone

(515) 451-0925

NPI assigned

Feb 19, 2024

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Avanzos Educational and Behavioral Services Community/Behavioral Health Agency · Kensington, MD · NPI 1639825896
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 19, 2024.

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1194580167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4107 MITSCHER CT",
            "city": "KENSINGTON",
            "state": "MD",
            "postal_code": "208951307",
            "telephone_number": "515-451-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4107 MITSCHER CT",
            "city": "KENSINGTON",
            "state": "MD",
            "postal_code": "208951307",
            "telephone_number": "515-451-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORD",
        "first_name": "RAVEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Kensington, MD · Behavior Technician in Maryland