Individual provider Active NPI

Jessamine Pilar Crespo- Gonzalez

  • Behavior Analyst
  • Cary, NC
National Provider Identifier
1528608080
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-22-63389
Practice address
111 Mackenan Dr
Cary, NC 27511-7903
Phone
(919) 371-2848
NPI assigned
Jan 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 1-22-63389 Primary

Addresses

Primary practice location

111 Mackenan Dr
Cary, NC 27511-7903

Mailing address

111 Mackenan Dr
Cary, NC 27511-7903

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Center for Autism Services, LLC Behavior Analyst PastSince Jan 19, 2020 Accepting new patients
The Carolina Center for ABA & Autism Treatment PastSince Jan 19, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1528608080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MACKENAN DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MACKENAN DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117903",
            "telephone_number": "919-371-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRESPO- GONZALEZ",
        "first_name": "JESSAMINE",
        "middle_name": "PILAR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-13",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-22-63389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.

Verify at the official NPI Registry.