Caitlin Lara Madelyn Powderly

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-46989 Issued in FL

Practice address

3665 Eloise St
Jacksonville, FL 32205-9006

Phone

(978) 408-9462

NPI assigned

May 7, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Nocal Behavioral Services LLC

  • Behavior Analyst
  • Ponte Vedra, FL
  • NPI 1184084782
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1669037453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3665 ELOISE ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322059006",
            "telephone_number": "978-408-9462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 ELOISE ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322059006",
            "telephone_number": "978-408-9462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWDERLY",
        "first_name": "CAITLIN",
        "middle_name": "LARA MADELYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "19-84604",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-21-46989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Poulsen, RDN
• Emily Pound
• Marjorie Teate Pound, ARNP
• Flora Chen Poveda, O.D.
• Snehider Poveda
• Aimee Powell, LMT
• Alix Corrin Powell, CRNA
• Aneisha Powell, NBC-HWC
• Annmarie Powell, MSW
• Anthony Javaris Powell

• Behavior Analyst in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.