Active NPI
Jackson Jeffery Ivy
- Behavior Technician
- Deerfield Beach, FL
National Provider Identifier
1235020702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 1235020702
- Practice address
- 350 Fairway Dr Ste 101
Deerfield Beach, FL 33441-1834 - Phone
- (512) 809-3109
- NPI assigned
- Jul 14, 2025
- 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 | 1235020702 | CA | Primary |
Addresses
Primary practice location
350 Fairway Dr Ste 101
Deerfield Beach, FL 33441-1834
Mailing address
3013 Oyster Bay Ave
Davis, CA 95616-2636
Phone (512) 809-3109
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 |
|---|---|---|---|
| 1235020702 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762300800000",
"number": "1235020702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3013 OYSTER BAY AVE",
"city": "DAVIS",
"state": "CA",
"postal_code": "956162636",
"telephone_number": "512-809-3109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 FAIRWAY DR STE 101",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334411834",
"telephone_number": "512-809-3109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVY",
"first_name": "JACKSON",
"middle_name": "JEFFERY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-14",
"last_updated": "2025-11-05",
"certification_date": "2025-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "1235020702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.