Active NPI
Jacquelyn Blake, M.ED.
- Behavior Analyst
- Plymouth, MA
National Provider Identifier
1346838836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 61 Elm St
Plymouth, MA 02360-1011 - Phone
- (781) 264-7954
- NPI assigned
- Jan 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
61 Elm St
Plymouth, MA 02360-1011
Mailing address
61 Elm St
Plymouth, MA 02360-1011
Phone (781) 264-7954
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
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610150400000",
"number": "1346838836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 ELM ST",
"city": "PLYMOUTH",
"state": "MA",
"postal_code": "023601011",
"telephone_number": "781-264-7954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 ELM ST",
"city": "PLYMOUTH",
"state": "MA",
"postal_code": "023601011",
"telephone_number": "781-264-7954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "JACQUELYN",
"credential": "M.ED.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-09",
"last_updated": "2021-01-09",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"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 Jan 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.