Active NPI
Stephen Erik Jacks, MS, BCBA
- Behavior Analyst
- Riverside, PA
National Provider Identifier
1669759478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 216 Dewart St.
Riverside, PA 17868-0086 - Phone
- (570) 204-6154
- NPI assigned
- Nov 8, 2011
- Last updated
- Nov 8, 2011
- 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 Analyst | 103K00000X | NU | Primary |
Addresses
Primary practice location
216 Dewart St.
Riverside, PA 17868-0086
Mailing address
216 Dewart St.
PO Box 86
Riverside, PA 17868-0086
Phone (570) 204-6154
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320710400000",
"number": "1669759478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 DEWART ST.",
"address_2": "PO BOX 86",
"city": "RIVERSIDE",
"state": "PA",
"postal_code": "178680086",
"telephone_number": "570-204-6154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 DEWART ST.",
"city": "RIVERSIDE",
"state": "PA",
"postal_code": "178680086",
"telephone_number": "570-204-6154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKS",
"first_name": "STEPHEN",
"middle_name": "ERIK",
"credential": "MS, BCBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-08",
"last_updated": "2011-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.