Active NPI
Gordon Anthony Defalco, BCBA-D,PHD,LABA
- Behavior Analyst
- Plymouth, MA
National Provider Identifier
1285713685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 882
- Practice address
- 16 Bridge Gate
Plymouth, MA 02360-6377 - Phone
- (508) 287-8692
- Fax
- (508) 591-7886
- NPI assigned
- Nov 4, 2006
- Last updated
- Sep 3, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 1-04-1493 | ||
| Behavior Analyst | 103K00000X | 882 | MA | Primary |
| Behavior Analyst | 103K00000X | 1-04-1493 | MA |
Addresses
Primary practice location
16 Bridge Gate
Plymouth, MA 02360-6377
Mailing address
16 Bridge Gate
Plymouth, MA 02360-6377
Phone (508) 287-8692
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 882 | MA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stonebridge Behavioral Services | Behavior Analyst | Past | Accepting new patients |
| South East Center for Swallowing & Communication | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Behavior Analyst
- Plymouth, MA
- NPI 1679829162
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- Speech-Language Pathologist
- New Bedford, MA
- NPI 1922102912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472860800000",
"number": "1285713685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 BRIDGE GATE",
"city": "PLYMOUTH",
"state": "MA",
"postal_code": "023606377",
"telephone_number": "508-287-8692",
"fax_number": "508-591-7886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 BRIDGE GATE",
"city": "PLYMOUTH",
"state": "MA",
"postal_code": "023606377",
"telephone_number": "508-287-8692",
"fax_number": "508-591-7886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFALCO",
"first_name": "GORDON",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "BCBA-D,PHD,LABA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-04",
"last_updated": "2016-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": "1-04-1493",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "882",
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "1-04-1493",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.