Individual provider Active NPI

Jessica Maria Mata, BCABA

  • Assistant Behavior Analyst
  • Miami Gardens, FL
National Provider Identifier
1730713744
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assistant Behavior AnalystTaxonomy code 106E00000X
Practice address
4800 NW 167TH St
Miami Gardens, FL 33014-6426
Phone
(305) 515-2726
NPI assigned
Feb 28, 2020
Last updated
Nov 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assistant Behavior Analyst 106E00000X Primary

Addresses

Primary practice location

4800 NW 167TH St
Miami Gardens, FL 33014-6426

Mailing address

11664 NW 90TH Ave
Hialeah Gardens, FL 33018-4156
Phone (305) 842-4984

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

OrganizationSpecialtyStatusNew patients
Lighting Behavior Services LLC CurrentSince Nov 19, 2023 Accepting new patients
Lighting Behavior Services LLC CurrentSince Oct 6, 2024 Accepting new patients
Crystal Minds Psychological Services PastSince Mar 1, 2022 Accepting new patients
Child Advancement Center Inc PastSince Feb 1, 2022 Accepting new patients

Locations

4800 NW 167th St
Miami Lakes, FL 33014
Phone (305) 515-2726

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1730713744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11664 NW 90TH AVE",
            "city": "HIALEAH GARDENS",
            "state": "FL",
            "postal_code": "330184156",
            "telephone_number": "305-842-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330146426",
            "telephone_number": "305-515-2726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "JESSICA",
        "middle_name": "MARIA",
        "credential": "BCABA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-28",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.