Jerome Anthony Coppage Jr., BCBA 1-21-55996

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-55996 Issued in CA

Practice address

30073 Via Amante
Menifee, CA 92584-8910

Phone

(619) 895-4615

NPI assigned

Feb 27, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Serv ABA LLC

  • Behavior Analyst
  • Menifee, CA
  • NPI 1396535969
  NPD
• PJD Enterprises LLC

  • Behavior Analyst
  • Santa Clarita, CA
  • NPI 1679248371
  NPD (past)

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1780141630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30073 VIA AMANTE",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925848910",
            "telephone_number": "619-895-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30073 VIA AMANTE",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925848910",
            "telephone_number": "619-895-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPAGE",
        "first_name": "JEROME",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "credential": "BCBA  1-21-55996",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-27",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT-16-4282-36534",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-21-55996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophavady Collins
• Connect Four
• Connections Family Therapy, Inc.
• Maria Contreras-Rodarte
• Julianna Copeland
• Jantenee A'Shanyse Corley-Milner
• Marisela Vanessa Corona
• Erica Coronado
• Corporate Talks Speech Pathology, Inc
• Nicholas Correa

• Behavior Analyst in Menifee, CA
• Providers in Menifee, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.