Active NPI
Jorge Jorie Polynice
- Behavior Analyst
- Mattapan, MA
National Provider Identifier
1649769399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-18-4001
- Practice address
- 55 Lorna Rd # 2
Mattapan, MA 02126-2618 - Phone
- (617) 407-5242
- NPI assigned
- May 8, 2018
- Last updated
- May 8, 2018
- 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 Analyst | 103K00000X | 1-18-4001 | MA | Primary |
Addresses
Primary practice location
55 Lorna Rd # 2
Mattapan, MA 02126-2618
Mailing address
55 Lorna Rd # 2
Mattapan, MA 02126-2618
Phone (617) 407-5242
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": "1525737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525737600000",
"number": "1649769399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 LORNA RD # 2",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262618",
"telephone_number": "617-407-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LORNA RD # 2",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262618",
"telephone_number": "617-407-5242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLYNICE",
"first_name": "JORGE",
"middle_name": "JORIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-08",
"last_updated": "2018-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "1-18-4001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.