Active NPI
Manuela Molina-Palacio, BS
- Behavior Technician
- Cumming, GA
National Provider Identifier
1679188288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-19-104115
- Practice address
- 4150 Deputy Bill Cantrell Memorial Rd
Suite T200
Cumming, GA 30040-3002 - Phone
- (470) 839-3041
- Fax
- (317) 520-8200
- NPI assigned
- Sep 10, 2020
- Sex
- Female
- Sole proprietor
- No
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 | RBT-19-104115 | GA | Primary |
Addresses
Primary practice location
4150 Deputy Bill Cantrell Memorial Rd
Suite T200
Cumming, GA 30040-3002
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
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
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-104115 | GA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creekside Autism Center | Behavior Technician | Past | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599696000000",
"number": "1679188288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4150 DEPUTY BILL CANTRELL MEMORIAL RD",
"address_2": "SUITE T200",
"city": "CUMMING",
"state": "GA",
"postal_code": "300403002",
"telephone_number": "470-839-3041",
"fax_number": "317-520-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLINA-PALACIO",
"first_name": "MANUELA",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-10",
"last_updated": "2020-09-10",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-19-104115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.