Active NPI
Juanita Brisco
- Intellectual & Developmental Disabilities Psychologist
- Milton, DE
National Provider Identifier
1659974087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- Practice address
- 28291 Fisher Rd
Milton, DE 19968-3273 - Phone
- (302) 573-1247
- NPI assigned
- Nov 18, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | Primary |
Addresses
Primary practice location
28291 Fisher Rd
Milton, DE 19968-3273
Mailing address
28291 Fisher Rd
Milton, DE 19968-3273
Phone (302) 573-1247
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250568415 | Medicaid | DE |
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": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1659974087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28291 FISHER RD",
"city": "MILTON",
"state": "DE",
"postal_code": "199683273",
"telephone_number": "302-573-1247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28291 FISHER RD",
"city": "MILTON",
"state": "DE",
"postal_code": "199683273",
"telephone_number": "302-573-1247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISCO",
"first_name": "JUANITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "250568415",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milton, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.