Jorge Daniel Carrasquillo

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-19-77372 Issued in CA

Practice address

1301 Redwood Way Ste 210
Petaluma, CA 94954-1107

Phone

(707) 806-9921

NPI assigned

Jun 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Momentum Behavior Services, LLC

  • Community/Behavioral Health Agency
  • Petaluma, CA
  • NPI 1356825541
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1700570694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 VERSAILLES ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954034212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 REDWOOD WAY STE 210",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541107",
            "telephone_number": "707-806-9921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASQUILLO",
        "first_name": "JORGE",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT-19-77372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debbie A Carpenter, CERTIFIED MASSAGE TH
• Amanda Faye Dragos Carr, IBCLC
• Ynhi Thanh Carr, PHARMD
• Alejandro Daniel Carranza
• Zoe Carrasco
• Lesley Anne Carrier, RD
• Robert M. Carriger, M.F.T.
• Aimee Carrillo
• Anthony Carrillo
• Sara W Carrington, PPS

• Behavior Technician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.