Individual provider Active NPI

Serena Twombly, BCBA

  • Behavior Analyst
  • Cromwell, CT
National Provider Identifier
1700519345
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
162 West St Ste F
Cromwell, CT 06416-4405
Phone
(860) 613-9930
Fax
(860) 613-9952
NPI assigned
Jul 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1491 CT
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

162 West St Ste F
Cromwell, CT 06416-4405

Mailing address

110 Court St Ste 3
Cromwell, CT 06416-1273
Phone (860) 613-9930

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

LicenseStateTypeSpecialty
1491CTMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Education Assessment Consultation Services CurrentSince Oct 15, 2023 Accepting new patients

Locations

110 Court St
Ste 3
Cromwell, CT 06416
Phone (860) 281-6271

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": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1700519345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COURT ST STE 3",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064161273",
            "telephone_number": "860-613-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 WEST ST STE F",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064164405",
            "telephone_number": "860-613-9930",
            "fax_number": "860-613-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TWOMBLY",
        "first_name": "SERENA",
        "name_prefix": "Mrs.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-01",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CT",
            "license": "1491",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cromwell, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.