Active NPI
Jackie Lively
- Behavior Technician
- Newburgh, IN
National Provider Identifier
1548073422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-298955
- Practice address
- 3777 Haley Dr
Newburgh, IN 47630-2608 - Phone
- (317) 249-2242
- Fax
- (844) 289-6798
- NPI assigned
- Jan 27, 2025
- 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 | RBT-23-298955 | IN | Primary |
Addresses
Primary practice location
3777 Haley Dr
Newburgh, IN 47630-2608
Mailing address
550 Congressional Blvd.
Suite 115
Carmel, IN 46032-5400
Phone (317) 249-2242
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 |
|---|---|---|---|
| RBT-23-298955 | IN | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1548073422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 CONGRESSIONAL BLVD.",
"address_2": "SUITE 115",
"city": "CARMEL",
"state": "IN",
"postal_code": "460325400",
"telephone_number": "317-249-2242",
"fax_number": "844-289-6798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3777 HALEY DR",
"city": "NEWBURGH",
"state": "IN",
"postal_code": "476302608",
"telephone_number": "317-249-2242",
"fax_number": "844-289-6798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVELY",
"first_name": "JACKIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-27",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": "RBT-23-298955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.