Active NPI
Robert Wayne Bouley
- Behavior Technician
- Enfield, CT
National Provider Identifier
1508438581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 139 Hazard Ave.
Building 2 Suite 6
Enfield, CT 06082-0608 - Phone
- (860) 218-3614
- NPI assigned
- Jul 11, 2021
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
139 Hazard Ave.
Building 2 Suite 6
Enfield, CT 06082-0608
Mailing address
482 Taylor Rd
Enfield, CT 06082-4047
Phone (413) 250-4144
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1508438581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "482 TAYLOR RD",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060824047",
"telephone_number": "413-250-4144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 HAZARD AVE.",
"address_2": "BUILDING 2 SUITE 6",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060820608",
"telephone_number": "860-218-3614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULEY",
"first_name": "ROBERT",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-11",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.