Fabiola Medrano

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-38867 Issued in FL

Practice address

125 Half Mile Rd Ste 200
Red Bank, NJ 07701-6749

Phone

(855) 832-6727

Fax

(772) 675-9100

NPI assigned

May 31, 2017

Last updated

May 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1386172625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HALF MILE RD STE 200",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077016749",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1563 Kingsley Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320734503",
            "country_code": "US",
            "telephone_number": "904-602-9740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDRANO",
        "first_name": "FABIOLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-31",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-19-38867",
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": "0-19-9575",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009093700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• MCM PT Service
• Carla P. McMenamy, PT
• Anne Camille McNamara, LCADC
• Celeste G Mecca
• Mediation and Therapy Associates LLC
• Michael Meerovich
• Shalini Mehra-Gupta, M.D
• Christina Meinsen, RPH
• Britt Melewski, LCSW
• Melinda L. Wagner DMD LLC

• Behavior Analyst in Red Bank, NJ
• Providers in Red Bank, 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 May 10, 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.

Verify at the official NPI Registry.