Active NPI
Jennifer Constance Braendeholm
- Behavior Analyst
- Baltimore, MD
National Provider Identifier
1245870450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- LBA739
- Practice address
- 400 E Pratt St
Baltimore, MD 21202-3116 - Phone
- (855) 832-6727
- NPI assigned
- Jan 15, 2020
- Last updated
- Jan 15, 2020
- Sex
- Female
- 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 Analyst | 103K00000X | LBA739 | MD | Primary |
Addresses
Primary practice location
400 E Pratt St
Baltimore, MD 21202-3116
Mailing address
400 E Pratt St
Baltimore, MD 21202-3116
Phone (855) 832-6727
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700024296 | Medicaid | MD | |
| 1700024296 | Other | MD | TRI CARE HUMANA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | teampbs.com | Direct |
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 |
|---|---|---|---|
| LBA739 | MD | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579046400000",
"number": "1245870450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E PRATT ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212023116",
"telephone_number": "855-832-6727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E PRATT ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212023116",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAENDEHOLM",
"first_name": "JENNIFER",
"middle_name": "CONSTANCE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-15",
"last_updated": "2020-01-15",
"certification_date": "2020-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MD",
"license": "LBA739",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1700024296",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRI CARE HUMANA",
"identifier": "1700024296",
"state": "MD"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "teampbs.com",
"affiliation": "N",
"endpointDescription": "company website",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "400 E Pratt St, Baltimore MD 21202-3116, US",
"address_1": "400 E Pratt St",
"city": "Baltimore",
"state": "MD",
"country_code": "US",
"postal_code": "212023116",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.