Active NPI
Jahroy Winston Jackson
- Behavior Technician
- Boca Raton, FL
National Provider Identifier
1619781259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB1180359
- Practice address
- 9970 Central Park Blvd N Ste 401
Boca Raton, FL 33428-2252 - Phone
- (305) 807-1909
- NPI assigned
- Feb 4, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | BACB1180359 | CT | Primary |
Addresses
Primary practice location
9970 Central Park Blvd N Ste 401
Boca Raton, FL 33428-2252
Mailing address
70 Weber Ave Apt 3B
Bridgeport, CT 06610-3038
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 |
|---|---|---|---|
| BACB1180359 | CT | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738627200000",
"number": "1619781259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 WEBER AVE APT 3B",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066103038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9970 CENTRAL PARK BLVD N STE 401",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334282252",
"telephone_number": "305-807-1909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JAHROY",
"middle_name": "WINSTON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-02-04",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CT",
"license": "BACB1180359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.