Individual provider Active NPI

Edymar Danielle Glines, BCBA

  • Behavior Analyst
  • Boca Raton, FL
National Provider Identifier
1679028773
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
433 Plaza Real Ste 275
Boca Raton, FL 33432-3999
Phone
(305) 632-8577
Fax
(786) 329-6452
NPI assigned
Aug 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

433 Plaza Real Ste 275
Boca Raton, FL 33432-3999

Mailing address

3370 Beau Rivage Dr Apt W6
Pompano Beach, FL 33064-2033
Phone (954) 825-9922

Other identifiers 1

IdentifierTypeStateIssuer
019419900MedicaidFL

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

Practice roles

OrganizationSpecialtyStatusNew patients
Foundations Therapy, Inc. PastSince Feb 6, 2022 Accepting new patients
Storybook ABA MD LLC Behavior Analyst Past Accepting new patients
Foundations Therapy, Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1679028773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3370 BEAU RIVAGE DR APT W6",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330642033",
            "telephone_number": "954-825-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 PLAZA REAL STE 275",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334323999",
            "telephone_number": "305-632-8577",
            "fax_number": "786-329-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLINES",
        "first_name": "EDYMAR",
        "middle_name": "DANIELLE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019419900",
            "state": "FL"
        }
    ],
    "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 Aug 24, 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.