Active NPI
Kyle Whitmore
- Behavior Analyst
- Woburn, MA
National Provider Identifier
1558731323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 3296-MH-B1
- Practice address
- 5 Constitution Way Ste C
Woburn, MA 01801-1199 - Phone
- (888) 754-0398
- NPI assigned
- Oct 5, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 3296-MH-B1 | MA | Primary |
| Developmental Therapist | 222Q00000X |
Addresses
Primary practice location
5 Constitution Way Ste C
Woburn, MA 01801-1199
Mailing address
101 Old Billerica Rd
Bedford, MA 01730-1222
Phone (781) 307-8413
Other practice location 1
1 Whitney Rd
Berlin, MA 01503-1653
Phone (855) 222-7980
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 |
|---|---|---|---|
| 3296-MH-B1 | MA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Autism Behavior Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Berlin, MA
- NPI 1750786505
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605830400000",
"number": "1558731323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 OLD BILLERICA RD",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017301222",
"telephone_number": "781-307-8413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 CONSTITUTION WAY STE C",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011199",
"telephone_number": "888-754-0398"
}
],
"practiceLocations": [
{
"address_1": "1 Whitney Rd",
"address_purpose": "LOCATION",
"city": "Berlin",
"state": "MA",
"postal_code": "015031653",
"country_code": "US",
"telephone_number": "855-222-7980",
"fax_number": "508-232-7935",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITMORE",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-05",
"last_updated": "2020-11-20",
"certification_date": "2020-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "3296-MH-B1",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.