Active NPI
Jacqueline Pecoraro
- Behavior Technician
- Bridgeton, MO
National Provider Identifier
1740885128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-158908
- Practice address
- 3859 Fee Fee Rd
Bridgeton, MO 63044-2937 - Phone
- (314) 410-9670
- NPI assigned
- Dec 2, 2020
- Last updated
- May 13, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Technician | 106S00000X | RBT-21-158908 | MO | Primary |
Addresses
Primary practice location
3859 Fee Fee Rd
Bridgeton, MO 63044-2937
Mailing address
306 N Kensington Ave
La Grange Park, IL 60526-1870
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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-21-158908 | MO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evergreen ABA LLC | Past | Accepting new patients | |
| Latitude Therapy Solutions LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Latitude Therapy
- Community/Behavioral Health Agency
- Saint Louis, MO
- NPI 1831663848
-
- Behavior Analyst
- Bentonville, AR
- NPI 1558128553
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1740885128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 N KENSINGTON AVE",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605261870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3859 FEE FEE RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442937",
"telephone_number": "314-410-9670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECORARO",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-02",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MO",
"license": "RBT-21-158908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
- Tochukwu Michelle Patrick
- Pattonville Fire Protection District
- Mahbubul B Patwary, MD
- Pavilion Health Company, LLC
- Pavilion Health Company, LLC (Pavilion Healthcare)
- Peer Review Consulting Services, Inc. (Performance Health of St Louis)
- Kristin Percy, OTR/L
- Isabel B Perez, MD
- Jeannie Ong Perez, MD
- Benjamin Daniel Perrin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.