Active NPI
Fanny Archel Mateo
- Behavior Technician
- Troy, IL
National Provider Identifier
1396699740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 1214416
- Practice address
- 411 Edwardsville Rd
Troy, IL 62294-1339 - Phone
- (314) 275-0506
- NPI assigned
- Feb 23, 2026
- Sex
- Female
- Sole proprietor
- No
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 Technician | 106S00000X | 1214416 | IL | Primary |
Addresses
Primary practice location
411 Edwardsville Rd
Troy, IL 62294-1339
Mailing address
848 N 89TH St
East Saint Louis, IL 62203-2111
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1214416 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1771804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771804800000",
"number": "1396699740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "848 N 89TH ST",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622032111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 EDWARDSVILLE RD",
"city": "TROY",
"state": "IL",
"postal_code": "622941339",
"telephone_number": "314-275-0506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATEO",
"first_name": "FANNY",
"middle_name": "ARCHEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-23",
"last_updated": "2026-02-23",
"certification_date": "2026-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": "1214416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.