Active NPI
Samuel Aaron Tissenbaum
- Behavior Technician
- Charleston, WV
National Provider Identifier
1205565918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB790322
- Practice address
- 888 Oakwood Rd Ste 300
Charleston, WV 25314-2071 - Phone
- (681) 265-0999
- NPI assigned
- Jun 8, 2022
- 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 | BACB790322 | WV | Primary |
Addresses
Primary practice location
888 Oakwood Rd Ste 300
Charleston, WV 25314-2071
Mailing address
888 Oakwood Road
Suite 300, Box 2
Charleston, WV 25314
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
| License | State | Type | Specialty |
|---|---|---|---|
| BACB790322 | WV | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1205565918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "888 OAKWOOD ROAD",
"address_2": "SUITE 300, BOX 2",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "25314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 OAKWOOD RD STE 300",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253142071",
"telephone_number": "681-265-0999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISSENBAUM",
"first_name": "SAMUEL",
"middle_name": "AARON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-08",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WV",
"license": "BACB790322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.