Ettil Kamenetzky, MS ED BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-3695 Issued in NJ

Practice address

11 Colorado Dr
Jackson, NJ 08527-2107

Phone

(516) 776-7834

NPI assigned

Dec 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Ettil Weiss Professional name

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

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    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1316586332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 COLORADO DR",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085272107",
            "telephone_number": "516-776-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 COLORADO DR",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085272107",
            "telephone_number": "516-776-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMENETZKY",
        "first_name": "ETTIL",
        "name_prefix": "Mrs.",
        "credential": "MS ED BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1-19-3695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LAKEWOOD",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LAKEWOOD",
            "address_1": "11 Colorado Dr",
            "city": "Jackson",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "085272107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LAKEWOOD",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LAKEWOOD",
            "address_1": "11 Colorado Dr",
            "city": "Jackson",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "085272107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LAKEWOOD",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LAKEWOOD",
            "address_1": "11 Colorado Dr",
            "city": "Jackson",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "085272107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ETTIL",
            "last_name": "WEISS",
            "prefix": "MRS.",
            "credential": "MS ED BCBA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Behavior Analyst in Jackson, NJ
• Providers in Jackson, NJ by specialty
• Behavior Analyst in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.