Individual provider Active NPI

Mimi Roh

  • Assistant Behavior Analyst
  • Orlando, FL
National Provider Identifier
1760020820
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assistant Behavior AnalystTaxonomy code 106E00000X
Practice address
8701 Maitland Summit Blvd
Orlando, FL 32810-5915
Phone
(866) 311-4617
Fax
(407) 965-4480
NPI assigned
Dec 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Assistant Behavior Analyst 106E00000X FL Primary

Addresses

Primary practice location

8701 Maitland Summit Blvd
Orlando, FL 32810-5915

Mailing address

907 Outer Rd Ste B
Orlando, FL 32814-6601
Phone (407) 217-1401

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

NPI Registry JSON

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1760020820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 OUTER RD STE B",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146601",
            "telephone_number": "407-217-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 MAITLAND SUMMIT BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105915",
            "telephone_number": "866-311-4617",
            "fax_number": "407-965-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROH",
        "first_name": "MIMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-19",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.

Verify at the official NPI Registry.