Active NPI
Keith Manuel Pavon, BA, MA
- Behavior Technician
- Newton, MA
National Provider Identifier
1700363090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 109 Oak St Ste 103
Newton, MA 02464-1493 - Phone
- (617) 658-5611
- NPI assigned
- Jul 19, 2018
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
109 Oak St Ste 103
Newton, MA 02464-1493
Mailing address
2 Haviland St Apt 2
Worcester, MA 01602-2109
Phone (787) 639-9662
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 Arts, Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531958400000",
"number": "1700363090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 HAVILAND ST APT 2",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016022109",
"telephone_number": "787-639-9662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 OAK ST STE 103",
"city": "NEWTON",
"state": "MA",
"postal_code": "024641493",
"telephone_number": "617-658-5611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVON",
"first_name": "KEITH",
"middle_name": "MANUEL",
"credential": "BA, MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-19",
"last_updated": "2018-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.