NPIMap

Organization Active NPI

Beacon Pediatric Behavioral Health

  • Psychologist
  • Jacksonville, FL
National Provider Identifier
1770838872
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BEACON PEDIATRIC BEHAVIORAL HEALTH
Practice address
6816 Southpoint Pkwy Ste 202
Jacksonville, FL 32216-1701
Phone
(904) 419-7792
Fax
(904) 900-7732
NPI assigned
Jul 16, 2012
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. Adrienne Leigh Desantis King, PHD, BCBA-D, NCSPNPI 1467605493
Title
Managing Member/Owner/Psychologist
Phone
(904) 419-7792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

6816 Southpoint Pkwy Ste 202
Jacksonville, FL 32216-1701

Mailing address

6816 Southpoint Pkwy Ste 202
Jacksonville, FL 32216-1701
Phone (904) 419-7792

Other practice location 1

12025 San Jose Blvd Ste 2
Jacksonville, FL 32223-1639
Phone (904) 419-7792

National Provider Directory

National Provider Directory

Locations

12025 San Jose Blvd
Ste 2
Jacksonville, FL 32223
Phone (904) 419-7792

6816 Southpoint Pkwy
Ste 202
Jacksonville, FL 32216
Phone (904) 419-7792

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1770838872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6816 SOUTHPOINT PKWY STE 202",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161701",
            "telephone_number": "904-419-7792",
            "fax_number": "904-900-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6816 SOUTHPOINT PKWY STE 202",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161701",
            "telephone_number": "904-419-7792",
            "fax_number": "904-900-7732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12025 San Jose Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322231639",
            "country_code": "US",
            "telephone_number": "904-419-7792",
            "fax_number": "904-900-7732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON PEDIATRIC BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-16",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "LEIGH DESANTIS",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "904-419-7792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, BCBA-D, NCSP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.