Active NPI
Derek Dube
- Behavior Technician
- Pawtucket, RI
National Provider Identifier
1205522893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 372 Vine St
Pawtucket, RI 02861-2703 - Phone
- (914) 338-2564
- NPI assigned
- Apr 17, 2023
- 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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
372 Vine St
Pawtucket, RI 02861-2703
Mailing address
372 Vine St
Pawtucket, RI 02861-2703
Phone (914) 338-2564
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": "1681689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681689600000",
"number": "1205522893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "372 VINE ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028612703",
"telephone_number": "914-338-2564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "372 VINE ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028612703",
"telephone_number": "914-338-2564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBE",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-17",
"last_updated": "2023-04-17",
"certification_date": "2023-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.