Active NPI
Dewayne Lavonte Rogers I
- Behavior Technician
- Lunenburg, MA
National Provider Identifier
1679119424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- S55356645
- Practice address
- 132 Robbs Hill Rd
Lunenburg, MA 01462-2167 - Phone
- (774) 270-1766
- NPI assigned
- Nov 26, 2019
- 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 Technician | 106S00000X | S55356645 | MA | Primary |
Addresses
Primary practice location
132 Robbs Hill Rd
Lunenburg, MA 01462-2167
Mailing address
9 Common St Apt 1L
Quincy, MA 02169-1663
Phone (857) 251-8996
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S55356645 | MA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Autism Connections, LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Behavior Analyst
- Lunenburg, MA
- NPI 1417468364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574726400000",
"number": "1679119424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 COMMON ST APT 1L",
"city": "QUINCY",
"state": "MA",
"postal_code": "021691663",
"telephone_number": "857-251-8996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "132 ROBBS HILL RD",
"city": "LUNENBURG",
"state": "MA",
"postal_code": "014622167",
"telephone_number": "774-270-1766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGERS",
"first_name": "DEWAYNE",
"middle_name": "LAVONTE",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-26",
"last_updated": "2019-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MA",
"license": "S55356645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lunenburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.