Active NPI
Theresa Woodburn
- Behavior Technician
- California, MD
National Provider Identifier
1700566775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 22593 Three Notch Rd
California, MD 20619-3202 - Phone
- (301) 862-2505
- Fax
- (301) 862-2548
- NPI assigned
- Jul 24, 2023
- 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 | Primary |
Addresses
Primary practice location
22593 Three Notch Rd
California, MD 20619-3202
Mailing address
22593 Three Notch Rd
California, MD 20619-3202
Phone (301) 862-2505
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Personalized Therapy, LLC | 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": "1690156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690156800000",
"number": "1700566775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22593 THREE NOTCH RD",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206193202",
"telephone_number": "301-862-2505",
"fax_number": "301-862-2548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22593 THREE NOTCH RD",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206193202",
"telephone_number": "301-862-2505",
"fax_number": "301-862-2548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODBURN",
"first_name": "THERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-24",
"last_updated": "2023-07-24",
"certification_date": "2023-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in California, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.