Jadine Sandra Wilson, M.ED, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LBA00229 Issued in RI

Practice address

610 Manton Ave
Providence, RI 02909-5633

Phone

(401) 263-7829

NPI assigned

Oct 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1336746155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 ATLANTIC AVE APT 4",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029071861",
            "telephone_number": "401-263-7829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 MANTON AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029095633",
            "telephone_number": "401-263-7829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JADINE",
        "middle_name": "SANDRA",
        "name_prefix": "Ms.",
        "credential": "M.ED, BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "RI",
            "license": "LBA00229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB",
            "identifier": "1-20-44001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH",
            "identifier": "LBA00229",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwilson@grodencenter.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "address_1": "610 Manton Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029095633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carol R. Wilson, LICSW
• Christina Elizabeth Wilson, DPT
• Connor Keith Wilson, MD, MPH
• Corinna Wilson, LMT
• Ira B. Wilson, MD
• Maurina Wilson, LCDP, LADC, CADC
• Nichole Wilson, NP
• Taneisha Wilson, M.D.
• Janet L Wilterdink, MD
• Sara Wilton, LMHC-A

• Behavior Analyst in Providence, RI
• Providers in Providence, RI by specialty
• Behavior Analyst in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.

Verify at the official NPI Registry.